TRAINING IN LAPAROSCOPIC CHOLECYSTECTOMY - QUANTIFYING THE LEARNING-CURVE

There is no clear consensus on the best way to train general surgeons to perform laparoscopic cholecystectomy (LC). We attempted to quantify the ''learning curve'' for 86 surgeons attending eight consecutive 3- day, three-pig courses in LC. Each step of the operation was scored by the instructor for successful performance: Uncomplicated pneumoperito neum (p), cystic duct and artery dissection (cd), artery and duct clip ping (cc), operative cholangiography (oc), gallbladder dissection with out holes (gd), liver bed hemostasis (h), gallbladder removal in one p iece (i), and no abdominal organ injury (in). As well, operative time, method of dissection, and contact Nd: YAG or electrocautery were reco rded. The percentage of students successfully completing each task for the first and third pigs on which they acted as surgeon was as follow s: [GRAPHICS] The operative time for the first and third pigs was 1.3 +/- 0.56 and 0.70 +/- 0.34 (mean +/- SD) h, respectively (P < 0.01). W hen students were trained with the contact Nd: YAG laser there was mor e blood loss than with electrosurgery (P < 0.001). Statistically signi ficant improvement could only be demonstrated in the most difficult ta sk, gallbladder dissection without perforation, but that task had not been mastered by the end of 3 days. The flat portion of the laparoscop ic cholecystectomy ''training curve'' had not been reached by the end of the program.