BN O06 - CHOLE-SAFE: A pilot curriculum response to reduce bile duct injuries

Abstract

Abstract Background The laparoscopic cholecystectomy is a cornerstone of modern benign upper GI surgery; approximately 3% of the population have symptomatic gallstones and over laparoscopic cholecystectomies 61,000 are performed every year in the UK (1). Whilst a relatively safe procedure, bile duct injury (BDI) is an iatrogenic catastrophe with significant consequences to both patient and surgeon. Despite understanding of how such injuries occur and pre-existing consensus methodology in minimising bile duct injuries (2,3); according to the bile duct injury registry incidence has increased. We present a novel curriculum in response. Method CHOLE-SAFE has been designed by expert panel with oversight from parent groups including AUGIS and BBUGSS. The course aims to convey a theoretical foundation in safe cholecystectomy, an understanding of relevant human factors in a no blame culture and provides a practical framework for managing difficult cases. A mixed methods course was delivered, with industry support, to a group of national training number registrars. We delivered a series of: didactic lectures, wet lab skills work and simulation and a written exam as a one-day course. Delegates were asked to provide feedback in an anonymous survey. Results Although delegates had varying experience, no trainee had performed more than 70 laparoscopic cholecystectomy. Two were experienced with X-ray cholangiogram however had only performed one. Most had ultrasound experience, however the average number of ultrasound cholangiograms performed was only 12. 36% of trainees had seen a BDI. There was no significant difference in procedural confidence after the course. Trainees felt more able to perform X-Ray and ultrasound cholangiogram independently (p<0.05). Before the course 72.7% of delegates felt they knew how to avoid a BDI, 36.4% felt able to manage one; this increased to 100% and 82% respectively after the course. Conclusion CHOLE-SAFE demonstrates a robust curriculum in the response to increased incidence of bile duct injury. Trainees benefit from increased understanding of how to avoid and manage complications and technical skill acquisition. Course delivery has been demonstrated to be replicable, feasible and practical to organise. We believe this curriculum to be necessary and addresses a significant training need.