THE LEARNING-CURVE FOR LAPAROSCOPIC CHOLECYSTECTOMY

The introduction of laparoscopic cholecystectomy (LC) in 1987 has resu lted in its wide acceptance by surgeons in the United States. Question s about proper training and learning curve for surgeons wishing to per form laparoscopic procedures have been raised during this period. We r etrospectively evaluated 416 consecutive cholecystectomy cases that we re performed by eight surgeons in a community teaching hospital. In th is report, 374 patients had LC and 42 patients (10%) had an attempted LC, which had to be converted to an open cholecystectomy (CONV). Surge ons A and B performed 40% and 18% of all LC cases, respectively, and w ere classified as the surgeons with the highest volume of cases. Param eters, including conversion rate, operative time, and complications, w ere evaluated to define the learning curve. Surgeons A and B experienc ed 17% and 14% initial conversion rates for the first 35 cases, respec tively. These rates dramatically dropped to an acceptable level (4% an d 3%) with increased experience. The operative time for surgeon A for the first and last 35 cases improved from 97 +/- 25 min to 74 +/- 32 m in (p = 0.01). Although the procedure time for surgeon B improved by 4 min, this difference was not statistically significant. The operative time for all cases was 81 +/- 31 min and 87 +/- 27 min, respectively, for surgeons A and B, which was significantly less than that for othe r surgeons (p = 0.01). A total of 12 patients experienced complication s related to LC. Most of the complications (75%) occurred in the first 30 cases for all surgeons. Analysis of our data reveals that there is a long learning curve for LC, as evidenced by conversion rates, opera tive time, and complication rates. We, therefore, conclude that LC has a definable learning curve and is a safe procedure with proper traini ng.