SAFE LAPAROSCOPIC CHOLECYSTECTOMY IN A COMMUNITY SETTING, N = 762

Laparoscopic cholecystectomy (LC) can be introduced into a community w ith morbidity and mortality rates equal to that of open cholecystectom y. The entire general surgical community of Greensboro, NC, learned th e technique of LC on animal models prior to offering this innovation t o the community. Over the ensuing 12 months, they served as surgeons o r assistant surgeons to each other on 762 LCs with morbidity and morta lity rates comparable to open cholecystectomy. This retrospective stud y examined the first 1 year of experience beginning 8/13/90. This work represents all of the LCs performed in Greensboro, and all of the sur geons participated in this review. All of the surgeries were done with an electrocautery and utilized a 0-degrees forward-viewing scope. Cas es were performed at two hospitals with a surgeon as both operator and assistant, and no effort was made to exclude high-risk or elderly pat ients from this procedure. Patients averaged 50 years of age and range d from 14 to % years. Static cholangiograms were performed in 27% of p atients. Conversion to open cholecystectomy was seen in 4.8%. There we re two cardiac deaths (0.26%) and significant complications were seen in 3.4%. Seven patients required reoperations. There were no major com mon bile duct injuries. This retrospective review indicates that this new procedure can be introduced into a community setting by novice lap aroscopic surgeons acting both as operators and assistant with a morbi dity and mortality rate comparable to that reported for open cholecyst ectomy.