The learning curve of laparoscopic cholecystectomy and changes in indications: One institutions's experience with 2650 cholecystectomies

Purpose: In a prospective series of 2650 consecutive patients undergoing ch olecystectomy, we analyzed the learning curve since the introduction of lap aroscopic cholecystectomy (LC) in terms of operating time, conversion rate, morbidity, mortality, and consequent changes in indications for either lap aroscopic or open cholecystectomy (OC). Patients and Methods: Between July 1990 and June 1997, LC was performed in 1929 patients (73%), 203 of whom (7.5%) had to be converted to OC, while 51 8 patients (19.5%) had primary OC. Patients having LC were predominantly fe male, younger, with less comorbidity and less complicated gallstone disease than patients having OC. Results: Barring a learning curve during the first 6 months of LC, operatin g time remained constant at an average of 71 minutes while operating on eve r more complex pathologies. The conversion rate decreased from 9.4% to 6.7% during the 7-year period. A relatively constant team of surgeons with grow ing experience as well as constantly improving technical equipment allowed the complication rate to remain low. The total morbidity of LC was 2.5% (0. 1% bile duct injury), that of conversions 5%, and that of OC 12.5%. The mor tality was 0 for LC, 0.5% for conversions, and 1% for OC. Conclusion: The indications for primary OC decreased from 50% to 8.5% and t he indications for LC could be broadened over the years.