HPB P58 Laparoscopic cholecystectomy as a training case in the post-Covid world

Abstract

Abstract Background Laparoscopic cholecystectomy is an index procedure for all higher surgical trainees, regardless of sub-specialty. Minimum numbers and evidenced ‘Level 4’ competency are necessary for successful completion of training. The Covid-19 pandemic led to falls in training opportunities, during the acute phase itself and in the current drive to reduce elective waiting lists. More cases are outsourced and those cases that are being performed in the NHS may be more complex due to longer waiting times. These twin pressures have led to concerns that training opportunities for laparoscopic cholecystectomy are being limited. This study evaluated the training opportunities for laparoscopic cholecystectomy. Methods All patients who had laparoscopic cholecystectomy over a four-month period, from January 2023 to April 2023 were identified from a prospectively maintained database of operations. Electronic patient records were interrogated to gather pre-operative data (symptomology, co-morbidities, acuity of presentation, pre-operative investigations), intra-operative findings and progress (grade of primary surgeon, nature of operation) and post-operative outcomes and complications. Factors which were associated with the case being performed by a trainee were assessed, as well as differences in outcomes between consultant and registrar procedures. Results There were 150 laparoscopic cholecystectomies performed during the study period. 79 (53%) of these cases were performed acutely ('hot' gallbladders). Registrars performed 36 elective laparoscopic cholecystectomies (51%) and 42 acute cases (53%). Operating time was comparable between registrars and consultants (median operating time [registrar vs. consultant], 72 vs. 78 minutes). There were no particular pre-operative factors that predicted a case being performed by a trainee. There were no differences in post-operative outcome or complication between grade of primary surgeon; there were no bile duct injuries. There were three patients who had a return-to-theatre (2 registrar, 1 consultant case). Conclusions The current case mix in our hospital has meant that just over half the laparoscopic cholecystectomies performed were completed by a trainee. Not a single case was performed by an 'SHO' level surgeon, suggesting that this operation is now the preserve of higher surgical trainees. Without a high-functioning acute gallbladder service, training opportunities for this operation would be severely limited. It is safe to train laparoscopic cholecystectomy, even in the acute setting, and more should be done to identify factors which could improve training opportunities.