Bile duct injury (BDI) and conversion rate (CR) in laparoscopic cholecystectomy (LC) performed by general surgery residents

Abstract

Introduction: LC is associated with a steep learning curve, with a higher incidence of BDI and conversions to open surgery in the first cases. The impact of simulation and hands on training is usually associated with a decrease in complications. Our aim was to investigate the rate of BDI and CR in LC performed by surgical residents, previously undergoing systematic simulation training, under supervision of faculty staff. Methods: Between june 2010 and june 2015, 1651 elective LC were performed by PGY2, PGY3 and PGY4 surgical residents, with previous and certified training in laparoscopic skills in our Training Center, assisted and supervised by faculty staff with an average experience of 1200 procedures (range 650-1800). Results: Of the total 1651 LC, 1074 (65.1%) were performed by PGY2, 359 (21.7%) by PGY3 and 218 (13.2%) by PGY4. There were a total of 91 (5.5%) conversions, 17 (1%) in LC performed by PGY2; 31 (1.8%), by PGY3 and 43 (2.6%), by PGY4. There were 2 (0.12%) BDI, 1 (0.06%) for a PGY3 and 1 (0.06%) for a PGY4, which corresponded to cases Nº115 and 147, respectively. No other major intraoperative or postoperative complications were attained. Conclusions:a)Simulation and hands on training for laparoscopic skills honing represent a very important aid in surgical education with ethical and medicolegal implications for surgical traineesb)Adequate supervision by expert staff allows surgical residents clinical exposure without an added increase in complications or BDI andc)Surgical patient safety should be a concern in academic teaching institutions.