Training background as a factor in the conversion rate of laparoscopic cholecystectomy

The present study reports findings concerning the impact of the learning en vironment on the conversion rate of laparoscopic cholecystectomy (LC) to op en cholecystectomy (OC). At Metro-West Medical Center (Framingham, MA) seve n surgeons performed 866 LCs between 1990 and 1995. Group I consisted of th ree surgeons who learned the procedure as part of their General Surgery Res idency training, whereas the remaining four surgeons representing Group II learned the procedure through private courses. We emphasize the importance of the surgeons' training background on the conversion rates, operative tim es, and length of hospitalization for patients undergoing LC: The conversio n rates, operative times, and complication rates were analyzed with and wit hout a 2-year period of adjustment to compensate for the learning curve of early procedures. Operative times and conversion rates from LC to OC were l ower for cases done by surgeons from Group I, even when the learning curve was corrected. The complication rates were higher for surgeons in Group II; but this did not reach statistical significance. As surgeons from Group II gained more experience their operation times and conversion rates decrease d. However, there still was a statistically significant difference in favor of surgeons who learned the procedure as part of a structured curriculum: These data suggest a long-lasting influence of the learning environment on the conversion rates and operative times.