Training Higher Surgical Trainees in Laparoscopic Common Bile Duct Exploration

Abstract

Laparoscopic common bile duct (CBD) exploration is regarded as a safe, definitive procedure for ductal calculi, avoiding the complications of endoscopic retrograde cholangiopancreatography. We aimed to evaluate the outcomes of laparoscopic CBD exploration carried out by trainees compared to those of an experienced consultant (R.W.M.). A prospective database of all cases of laparoscopic CBD exploration over a 15-year period was analyzed retrospectively. All patients underwent a four-port technique and intraoperative cholangiography. Patient demographics, operative technique, success, and complications were analyzed. The median age of patients undergoing laparoscopic CBD exploration was 65 years (range 14-94 years). In all, 187 (79%) of the CBD explorations were performed by one consultant and 48 (21%) by trainees. Calculi were successfully cleared in 141 (88%) and 43 (96%), respectively. There were two (<1%) conversions to an open procedure in the total group. The median operating time was 130 minutes in the consultant group versus 150 minutes in the trainee group (p < 0.05, Mann-Whitney U-test). There was no significant difference in CBD clearance rate, surgical approach, or complication rate between consultant and trainees (Fisher's exact test). Laparoscopic CBD exploration is a safe procedure in both consultant and trainee hands. With appropriate training, surgical trainees can achieve equivalent outcomes in CBD clearance with no significant difference in complication rates.