THE LEARNING-CURVE FOR LAPAROSCOPIC CHOLECYSTECTOMY

BACKGROUND: The use of laparoscopic surgical procedures without previo us training has grown rapidly. At the same time, there have been alleg ations of increased complications among less experienced surgeons, MET HODS: Using multivariate regression analyses, we evaluated the relatio nship between bile duct injury rate and experience with laparol scopic cholecystectomy for surgeons in the Southern Surgeons Club, RESULTS: Fifty-five surgeons performed 8,839 procedures. Fifteen bile duct inju ries (by 13 surgeons) resulted with 90% of the injuries occurring with in the first 30 cases performed by an individual surgeon. Multivariate analyses indicated that the only significant factor associated with a n adverse outcome was the surgeon's experience with the procedure. A r egression model predicted that a surgeon had a 1.7% chance of a bile d uct injury occurring in the first case and a 0.17% chance of a bile du ct injury at the 50th case, CONCLUSIONS: While surgeons appear to lear n this procedure rapidly, institutions might Consider requiring surgeo ns to move beyond the initial learning curve before awarding privilege s.