Laparoscopic and conventional cholecystectomy. Didactic concept for training and introduction of laparoscopic cholecystectomy and preventing complications

Abstract

This study has assessed the suitability of an educational concept for the introduction and training of laparoscopic cholecystectomy, a newly established operational procedure, within an university teaching hospital with a large number of surgeons. Since introduction of the first laparoscopic cholecystectomy all cholecystectomies were prospectively assessed over a period of two years (from May 1990 till May 1992). The educational concept applied was such that a given surgeon would first receive training from an instructor for 15 procedures and then assume responsibility for instruction of a subsequent trainee. In two years 355 patients underwent cholecystectomy. 60% of the operations were performed laparoscopically and 40% of the operations performed openly. During the two year period 13 surgeons were trained in the new technique, with an average of 16 operations per surgeon. Throughout the introductory phase there were no serious complications, and in particular no damage to the bile duct. The advantage of this introductory training phase has repeatedly been subject of discussion in the literature. In the meanwhile guidelines from specialist bodies and national institutions exist for regulating the education of new surgical techniques. In the past few years introduction to new techniques has gradually shifted toward training on the skill-stations and virtual reality trainers. The described educational concept for the introduction and training of laparoscopic cholecystectomy has been well approved and accepted since the early 90's.