CANADIAN LAPAROSCOPIC SURGERY SURVEY

Objective: To assess the status of laparoscopic general surgery in Can ada and the training experience and educational needs of Canadian surg eons, particularly with laparoscopic cholecystectomy (LC). Design: All of Canada's practising general surgeons were surveyed by mail approxi mately 15 months after the general availability of laparoscopic video equipment. Questionnaires completed by 736 surgeons form the basis of the analysis.Setting. The respondent profile produced a good sample di stribution to assess differences related to age, experience, location and type of practice; 30% practised in communities of 50 000 or less; 38% in hospitals with 250 or fewer beds and 57% in community hospitals . Results: Eighty-four percent had already learned LC, and 51% of them had performed more than 25 LCs. The number performed correlated direc tly with the number of cholecystectomies usually performed yearly befo re laparoscopy. Age and lack of relevance to practice were reasons for not learning. Ninety-one percent took formal training courses, usuall y university sponsored and in Canada. Complications were experienced b y 44% of respondents. Bile leak (26%), hemorrhage (15%) and bile-duct injury (9%) were the most common and increased as the number of cholec ystectomies usually performed prior to LC increased. Age, sex, type an d location of hospital and size of city were not significant factors. The data show a consistent (p < 0.001) increase in the proportion of s urgeons who encountered a complication as the number of LCs performed increased. Conclusions: LC has been introduced in Canada in an unpredi cted, rapid and seemingly orderly and responsible fashion in all areas , types and sizes of communities. It has been equally well applied by surgeons of all ages and size of practice whether practising in the sm aller community or in the university centre. The dogma of complication s releated to a ''learning curve'' is not supported by the author's da ta, and experience with complications is not restricted to the occasio nal biliary surgeon. Continued vigilance is necessary.