Simulation training of intraoperative complication management in laparoscopic cholecystectomy for novices—A randomized controlled study

Abstract

BackgroundIntraoperative complications occur more often in laparoscopic cholecystectomies (LCs) than in open cholecystectomies. Since LC is a frequent training procedure, surgical residents should be trained to deal with intraoperative complications in a safe and controlled environment. This study aimed to determine whether structured training in coping mechanisms in complication management in LC benefits novices compared to no training in complication management. MethodsThe study included sixty medical students without prior experience in minimally invasive surgery. They were randomly assigned to the intervention or control group and worked in teams of two. Both groups completed multimodal skill training, including one ex-vivo porcine LC. The intervention group (n=30) was then informed about the complications that can occur during an LC and how to manage them using the Coping Mechanisms for Intraoperative Complication Management in Laparoscopic Cholecystectomy (COMIC-LC) tool specially developed for this study. Afterward, they performed two LCs receiving structured training in coping mechanisms for intraoperative complication management. The control group (n=30) performed two LCs, receiving no information about managing complications. Both groups performed two postinterventional LCs. Complication management of the two groups was evaluated using the COMIC-LC assessment score. ResultsThe intervention group demonstrated better management of intraoperative complications in LCs compared to the control group (gallbladder perforation: 8.5 vs. 3.0 points, p<0.001; injury to the liver parenchyma: 7.0 vs. 2.0 points, p<0.001; cystic artery injury: 8.0 vs. 5.0 points, p<0.001; cystic duct injury: 6.0 vs. 1.0, p<0.001). ConclusionStructured training in coping mechanisms for managing intraoperative complications during LC can improve complication handling and potentially reduce adverse events. Translation to clinical practice should be evaluated.