LAPAROSCOPIC CHOLECYSTECTOMY IN A SURGICAL TRAINING-PROGRAM

Objective: To assess the impact of the introduction of the laparoscopi c cholecystectomy on surgical training, and the outcome of laparoscopi c cholecystectomies performed by residents compared with those of surg eons. Design: Retrospective analysis. Setting: University hospital, Th e Netherlands. Subjects: 943 Patients who underwent cholecystectomies from January 1987-December 1993 by residents and surgeons. In 527 pati ents the cholecystectomy was open and in 416 laparoscopic. Main outcom e measures: The percentage of cholecystectomies done by residents in t he period 1987-1993. The outcome of laparoscopic cholecystectomies don e by surgeons and residents in terms of duration of operation, convers ion rate, postoperative complications, and hospital stay. Results: Bef ore the laparoscopic era about 70% of all cholecystectomies were done by residents. After its introduction in 1990, the residents did 38% of the laparoscopic cholecystectomies in 1991, 39% in 1992, and 64% in 1 993. There were no differences in outcome of laparoscopic cholecystect omy in terms of duration of operation, conversion rate, postoperative complications and hospital stay between surgeons and residents. Conclu sions: The introduction of laparoscopic cholecystectomy caused a tempo rary decline in the number of cholecystectomies done by residents. Lap aroscopic cholecystectomy was integrated as a standard surgical proced ure in the residents' training programme within two years of its intro duction. The outcome of laparoscopic cholecystectomies done by supervi sed residents and surgeons was similar, and so laparoscopic cholecyste ctomy should be part of residents' training.