Experience Of Cholecystectomy Research Articles

Artificial Intelligence Identifies Factors Associated with Blood Loss and Surgical Experience in Cholecystectomy

Artificial Intelligence Identifies Factors Associated with Blood Loss and Surgical Experience in Cholecystectomy

Initial experience of robotic-assisted cholecystectomy in a tertiary care teaching hospital

Abstract Background: Robotic surgery was designed to overcome some of the major limitations of laparoscopy in terms of visibility, dexterity and precision. However, its potential limitations include high costs and low tactile feedback. at a tertiary care teaching hospital. Methods: In this retrospective study, we assessed the safety and feasibility of robotic-assisted cholecystectomy using the Versius Surgical Robot System® at our tertiary care teaching hospital between 2 September 2021 and 22 August 2022. Results: Of the 30 patients studied, 11 were males. The mean body mass index of the patients was 25.7. Intraoperative complications were noted in one case (haemorrhage from the liver bed) and conversion to laparoscopic surgery was noted in the same case. The median docking time was 16 min and the median console time was 72 min. No post-operative complications were noted. Both docking time and console time significantly decreased throughout this study. Conclusions: This study shows that the robotic-assisted cholecystectomy is a promising, safe and feasible alternative to traditional laparoscopic cholecystectomy.

Exploring Serum Lipid Profile Changes in Patients During Laparoscopic Choecystectomy

Background: For quite some time, cholecystectomy has been perceived as a safe surgical procedure, often with limited attention given to potential secondary effects. It's worth noting that the gallbladder plays a significant role as a regulatory component in coordination with vital metabolic pathways responsible for maintaining equilibrium in the body. When the gallbladder is removed, bile from the liver flows directly into the upper portion of the intestine. Therefore, this study aims to evaluate the impact of laparoscopic cholecystectomy on the serum lipid profile of patients. Material and methods: A total of 60 patients diagnosed with gallstones were enrolled in this study. Preoperative blood samples were collected from all patients under sterile conditions, two hours prior to their scheduled surgery, to evaluate their lipid profile. Results: The preoperative mean Total Cholesterol (TC) levels were measured at 160.5 mg%, while postoperatively, they showed a slight decrease to 150.8 mg%. Similarly, the mean High-Density Lipoprotein Cholesterol (HDL-C) levels before surgery were 42.1 mg%, and they decreased to 40.8 mg% after the procedure. In contrast, the mean Triglyceride (TG) levels saw an increase from 180.8 mg% preoperatively to 200.8 mg% postoperatively. Notably, the comparison of mean TC and TG levels before and after the surgery yielded significant results, indicating changes in these lipid parameters following laparoscopic cholecystectomy. Conclusion: Patients undergoing laparoscopic cholecystectomy experience noteworthy changes in their serum lipid profile.

EGS P16 Laparoscopic cholecystectomy for acute cholecystitis versus diagnostic laparoscopy for suspected appendicitis: comparative time of admission to theatre and impact on reaching national guidance

Abstract Background Early laparoscopic cholecystectomy for acute cholecystitis reduces intra-operative complications. National AUGIS guidelines therefore propose laparoscopic cholecystectomy should be performed within 72 hours of diagnosis. Locally, laparoscopic cholecystectomies for acute cholecystitis are preferentially performed within Emergency General Surgery (EGS) theatres whilst diagnostic laparoscopies for suspected appendicitis within CEPOD. Access to EGS is anecdotally challenging when compared with CEPOD. Patients with acute cholecystitis may subsequently experience longer times from admission to theatre. This project aimed to compare patient timelines from admission/booking to theatre and evaluate the impact on reaching national AUGIS guidance, intra-operative findings and intra-operative drain insertions. Methods Retrospective analysis of patient records at a single tertiary centre was performed. All patients that underwent a laparoscopic cholecystectomy for imaging-confirmed acute cholecystitis (n=66) alongside patients who underwent diagnostic laparoscopy +/- appendicectomy for suspected acute appendicitis (February-June 2022) (n = 62) were included. Time from admission/booking to theatre was determined and independent t-tests performed for statistical comparison. Associations between prolonged waiting times (>72 hours) and severity of intra-operative findings (Parkland scores) (ordinal regression analysis) / intra-operative drain insertion (Chi squared analysis) were analysed. Results Patients undergoing laparoscopic cholecystectomies waited significantly longer from both admission to theatre and booking to theatre compared to patients undergoing diagnostic laparoscopy for suspected appendicitis (71.4 hours vs. 33.33 hours, mean difference 38.07 hours, p=<0.001; 26.93 hours vs. 15.57 hours, mean difference 11.36 hours, p=0.002;). 63.6% of laparoscopic cholecystectomies were performed within 72 hours of admission. Waiting over 72 hours for laparoscopic cholecystectomy was not associated with increased severity of intra-operative findings (higher Parkland scores) (estimate 0.40, p=0.519) or drain insertion (Chi-squared 0.886a, p=0.347). Mean age 57.2 years (range 19-93) and 36.3 (range 8-86) for cholecystectomy versus diagnostic laparoscopy, respectively. Conclusions Patients awaiting laparoscopic cholecystectomy experience significantly longer waiting times from admission and booking to theatre when compared to those awaiting diagnostic laparoscopy for suspected appendicitis. Local concordance with national AUGIS guidance is variable and a proportion of patients with acute cholecystitis wait beyond 72 hours for laparoscopic cholecystectomy. Waiting >72 hours within this tertiary centre is not, however, reflected by intra-operative findings or intra-operative drain insertion. Completion of laparoscopic cholecystectomies within CEPOD should be considered for cases of acute cholecystitis to minimise wait times.

Early vs. Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis – A Single Center Study

Introduction: Laparoscopic cholecystectomy is regarded as the gold standard for the treatment of acute cholecystitis; however the timing of the procedure is controversial. There exist studies that support both early and delayed laparoscopic cholecystectomy. Aim: The aim of the study is to determine which modality: early or delayed laparoscopic cholecystectomy is the preferred timing in the treatment of acute cholecystitis by examining: duration of hospitalization, conversion rate, duration of surgery and intraoperative, postoperative complications. Materials and Methods: This was a retrospective study of 300 patients. Laparoscopic cholecystectomy was performed within 72 hours of admission for patients in the Early LC Group. Patients in the Delayed LC group were treated conservatively and discharged They were readmitted 6-12 weeks later for elective laparoscopic. Results: The mean operating time was 83.55 mins vs. 60.72 mins in the delayed group, conversion rate in Early LC Group was 5.3% vs. 8.0 % in the delayed LC group. The mean postoperative hospital stay was 1.98 days in the earlier group and 3.35 days in the delayed group. Overall mortality was zero. Conclusion: Early laparoscopic cholecystectomy within 72 hours of symptom onset offers both medical and economic benefits and should be the preferred method for patients treated by surgeons with adequate laparoscopic cholecystectomy experience.

Use of Critical View of Safety and Proctored Preceptorship in Preventing Bile Duct Injury During Laparoscopic Cholecystectomy-Experience of 3726 Cases From a Tertiary Care Teaching Institute.

Bile duct injury (BDI) continues to occur despite technological advances and improvements in surgical training over the past 2 decades. This study was conducted to audit our data on laparoscopic cholecystectomies performed over the past 2 decades to determine the role of Critical View of Safety (CVS) and proctored preceptorship in preventing BDI and postoperative complications. All patients undergoing elective laparoscopic cholecystectomy were analyzed retrospectively. The data were obtained from a prospectively maintained database from January 2004 to December 2019. Proctored preceptorship was used in all cases. Intraoperative details included the number of patients where CVS was defined, number of BDI and conversions. Postoperative outcomes, including hospital stay, morbidity, and bile duct stricture, were noted. Three thousand seven hundred twenty-six patients were included in the final analysis. Trainee surgeons performed 31.6% of surgeries and 9.5% of these surgeries were taken over by the senior surgeon. A CVS could be delineated in 96.6% of patients. The major BDI rate was only 0.05%. This study reiterates the fact that following the basic tenets of safe laparoscopic cholecystectomy, defining and confirming CVS, and following proctored preceptorship are critical in preventing major BDI.

Management of Acute Cholecystitis in Elderly (≥65 years old) Patients: A Retrospective Study Comparing Early versus Delayed Cholecystectomy

Aim: Acute cholecystitis is the most common causes of acute abdomen in elderly population. This study aimed to present the early postoperative period (≤ 30 days) outcomes of elderly patients (≥ 65 years old) with acute cholecystitis who underwent early or delayed cholecystectomy. Methods: Between January 2016 and December 2020, 74 patients aged 65 and over underwent cholecystectomy for acute cholecystitis were included in the study. The patients were divided into two groups as early (time between diagnosis and cholecystectomy 7 days or less, n= 43, 58.1%) or delayed (time between diagnosis and cholecystectomy over 7 days, n= 31, 41.9%) cholecystectomy. Demographic characteristics, preoperative laboratory and radiological findings, and perioperative data of patients were evaluated, and the groups were compared. Results: The median age of patients was 73 (65-90) years, and 39 (52.7%) were male. Sixty-one (82.4%) patients underwent laparoscopic, 8 open (10.8%) and 5 (6.8%) conversion cholecystectomy. The rate of laparoscopic cholecystectomy was higher in the delayed group (n= 29, 93.5%) than in the early group (n= 32, 74.4%), but no statistically significant difference was detected (p=.06). The rate of open cholecystectomy was statistically significantly higher in the early group (n=8, 18.6%) than in the delayed group (n=0) (P=.017), the conversion rate was similar between the groups (p=1). There was no significant difference between the groups in terms of intraoperative complications (p=1). The length of hospital stay was statistically significantly longer in the early compared to the delayed group 5 (1-21) days and 2 (1-12) days, respectively, p< .001). Conclusion: There was no statistical difference regarding intraoperative complications in patients underwent early or delayed cholecystectomy. We believe that the patient's clinical presentation and early or delayed cholecystectomy experience of the team are vital in determining the timing of cholecystectomy, as well as the severity of acute cholecystitis.

Our initial single port robotic cholecystectomy experience: A feasible and safe option for benign gallbladder diseases.

Although single-port laparoscopic cholecystectomy has been performed for over 25 years, it is still not popular. The narrow working space used in this surgery limits the movement of instruments and causes ergonomic challenges. Robotic surgery not only resolves the ergonomic challenges of single-port laparoscopic surgery but is also considered a good option with its additional technical advantages, like a three-dimensional display and not being affected by tremors. However, the extent to which these technical and ergonomic advantages positively affect the surgical outcomes and how safe the single-port robotic surgeries need to be assessed for each particular surgery. To evaluate the feasibility and safety of single-port robotic cholecystectomy for patients with cholelithiasis. The electronic records of the first 40 consecutive patients with gallbladder lithiasis who underwent single-port robotic cholecystectomy from 2013 to 2021 were analyzed retrospectively. In addition to the demographic characteristics of the patients, we analyzed American Society of Anesthesiologists (ASA) scores and body mass index. The presence of an accompanying umbilical hernia was also noted. The amount of blood loss during the operation, the necessity to place a drain in the subhepatic area, and the need to use grafts during the closure of the fascia of the port site were determined. Hospital stay, readmission rates, perioperative and postoperative complications, the Clavien-Dindo complication scores and postoperative analgesia requirements were also evaluated. The mean age of the 40 patients included in the study was 49.5 ± 11.6 years, and 26 were female (65.0%). The umbilical hernia was present in 24 (60.0%) patients, with a body mass index median of 29.3 kg/m2 and a mean of 29.7 ± 5.2 kg/m2. Fifteen (37.5%) of the patients were evaluated as ASA I, 18 (45.0%) as ASA II, and 7 (17.5%) as ASA III. The mean bleeding amount during the operation was 58.4 ± 55.8 mL, and drain placement was required in 12 patients (30.0%). After port removal, graft reinforcement during fascia closure was preferred in 14 patients (35.0%). The median operation time was 93.5 min and the mean was 101.2 ± 27.0 min. The mean hospital stay was 1.4 ± 0.6 d, and 1 patient was readmitted to the hospital due to pain (2.5%). Clavien-Dindo I complications were seen in 14 patients (35.0%), and five (12.5%) complications were wound site problems. In addition to the technological and ergonomic advantages robotic surgery provides surgeons, our study strongly supports that single-port robotic cholecystectomy is a feasible and safe option for treating patients with gallstones.

Robotic Radical Cholecystectomy Experience from a Single Tertiary Referral Center

Gallbladder adenocarcinoma is most often diagnosed at an advanced age, and a minimally invasive approach has potential to significantly reduce the morbidity of resection. There is little data regarding the safety and adequacy of a robotic radical cholecystectomy. We sought to evaluate the outcomes of our experience with robotic resection at our institution.

Laparoscopic Cholecystectomy Experience in District General Hospital from January 2018 – October 2019

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstones. However, to avoid serious biliovascular injury, conversion is advocated for distorted anatomy at the Calot’s triangle. This study aimed to review our experience handling elective LC cases, (simple and difficult) as a district general hospital.

Early Outcomes of Robotic Single Site Cholecystectomy Using the DaVinci Xi® System.

Purpose:Robotic surgery has become an established alternative to conventional laparoscopy or single site laparoscopy by solving the problems of angulation, improving the ergonomics of single-incision technology, and overcoming the intrinsic limitations of single-incision laparoscopy. Although the robotic single site technology is non-wristed and, unlike other conventional robotic instruments, only provides rotation, the ergonomics are nevertheless excellent. Therefore, the objective of this study is to present our initial experience in robotic single site cholecystectomy (RSSC) by a surgeon. Through this, we suggest that RSSC could be a feasible and safe procedure for overcoming the shortcomings of single incision laparoscopic cholecystectomy (SILC).Methods:This study is a retrospective data review of 74 patients who underwent RSSC between April 2019 and August 2020 at our institution. The demographic, pre-, and postoperative data were retrospectively collected.Results:A total of 74 patients underwent RSSC. The mean age of patients was 44.7 ± 9.5 years, and their mean body mass index was 24 ± 3 kg/m2. Symptomatic gallbladder stone (56.8%) was the most common pre-operative diagnosis. Mean of total operation and docking times was 39.3 ± 12.5 (20 – 85) and 7.6 ± 3.1 (4 – 20) minutes, respectively. There was no conversion, additional port insertion, bleeding, or intra-operative complication; however, one patient had wound seroma.Conclusions:RSSC for uncomplicated gallbladder disease may serve as an excellent alternative to SILC or conventional laparoscopic cholecystectomy because of its low complication rates, good cosmesis, and ease of reproducibility without a substantial learning curve.

Virtual reality laparoscopic simulator

Background: Virtual reality laparoscopic simulators were introduced to provide an optimal and safe learning environment for surgical trainees. The simulators had been validated and proven to be beneficial. Materials and Methods: The aim of this study is to assess the performance of the local surgical trainees using a validated simulator and help in the development of a training program using the simulator. Prospective repeated measures study in a single center using a validated virtual reality simulator was performed. Years 1 and 2 local postgraduate surgical trainees with limited laparoscopic cholecystectomy experience were included in the study. The trainees underwent a proposed training module, and the simulator evaluated each performance. Comparison was made between the performance before and after the training module. Results: Nine surgical trainees (eight males, median age: 33 years old) with a median of 5 years of surgical experience after graduation were included in the study. The time to complete each basic laparoscopic skill improved between 26.5% and 64.3% (P Conclusion: Virtual reality laparoscopic training should be implemented as part of training as it improves certain skill sets.

Kidney and pancreas transplant recipients undergoing cholecystectomy experience superior outcomes in transplant centers

BackgroundThis retrospective analysis aims to identify differences in surgical outcomes between pancreas and/or kidney transplant recipients and the general population undergoing cholecystectomy. MethodsMultivariate logistic regression and linear regression tests computed odds ratios (OR) and coefficients of the linear regression by analyzing weighted data from the NIS database between 2005 and 2014 to identify differences in mortality, morbidity, length of stay (LOS) and costs amongst KTx, PTx, PKTx, and non-Tx undergoing cholecystectomy in all centers and transplant centers. ResultsOverall 6007 KTx, 164 PTx, 535 PKTx, and 4,207,241 non-Tx met the inclusion criteria. Mortality from cholecystectomy was 1.0%. Transplant recipients did not experience a significant increase in mortality. However KTx and PTx suffered increased morbidity risks (KTx OR1.244 p < 0.01; PTx OR2.165 p < 0.01) compared to non-Tx. However transplant recipients did not incur an increased morbidity risk in transplant centers. ConclusionTransplant recipients undergoing cholecystectomy should be counseled about their increased complication risks. Surgeons should consider transferring KTx and PTx to transplant centers for their cholecystectomy procedure to mitigate these risks.

Surgical Trainee Experience with Open Cholecystectomy and the Dunning-Kruger Effect

Laparoscopic cholecystectomy has become the standard approach to gallbladder surgery, but open cholecystectomy retains a role in complex cases. The aim of this study was to evaluate exposure of senior trainees in general surgery to open cholecystectomy and their experience and confidence in independent performance. General surgical trainees on a higher surgical training programme from surgical training years 5 (ST 5) to 8 (ST8) were invited to partake in an online anonymous survey. Data pertaining to case numbers, whether supervised or independently performed and level of comfort were collated and analyzed. Twenty-six of 40 trainees responded (65%). Twenty-one (81%) had performed over 40 laparoscopic cholecystectomies with their trainer either scrubbed or un-scrubbed in theatre. As to open cholecystectomy experience, 12 trainees had assisted in 5 or fewer cases and only 3 assisted in over 20; 17 (65%) had performed 2 or fewer cases whilst assisted by their trainer while 24 of 26 trainees (92%) had no independent experience of open cholecystectomy. However, 16 felt they would be "somewhat comfortable" and 2 reported feeling "very comfortable" while only 8 reported they were "not comfortable" converting to open cholecystectomy. This study confirms a steep decline in training opportunities in open cholecystectomy, but also raises concern about a Dunning-Kruger effect as, despite this lack of experience, the majority felt "somewhat comfortable" or "very comfortable" in converting to open surgery. Trainees need first to be familiar with safer alternatives to conversion. Surgical trainers need to consider the assessment of confidence as well as competence as an endpoint of trainee evaluation.

Influence of prior appendectomy and cholecystectomy on Clostridioides difficile infection recurrence and mortality

BackgroundRemote appendectomy was linked to increased incidence of Clostridioides difficile infection (CDI). We evaluated the effect of absence of vermiform appendix and/or gallbladder on recurrence rate and severity of CDI. MethodsWe assessed a systemwide patient cohort diagnosed with initial CDI in 2014 (n = 250). The primary outcome was recurrence. ResultsAppendix and gallbladder were absent among 47 and 64 patients, respectively. CDI recurrence rate was similar among patients without and with appendix (24/47, 51.1% versus 90/203 patients, 44.3%; p = 0.404) and similar among patients without and with gallbladder (29/64 patients, 45.3% versus 85/186 patients, 45.7%; p = 0.957). Mortality was similar between appendectomy versus appendix in situ patients (3/47, 6.4% versus 9/203, 4.4%; p = 0.573), but higher mortality rate was seen among those without gallbladder (7/64 patients with prior cholecystectomy, 10.9% versus 5/186 patients with intact gallbladder, 2.7%; p = 0.008). ConclusionClostridioides difficile recurrence rate is not affected by remote appendectomy or cholecystectomy. Patients with prior cholecystectomy experience higher mortality rates associated with their CDI.

Evaluation of the usefulness of the SAGES Safe Cholecystectomy Program from the viewpoint of the European surgeon.

IntroductionCommon bile duct injury (CBDI) is a severe complication of laparoscopic cholecystectomy (LC). To minimize its occurrence, SAGES established the Safe Cholecystectomy Program (SCP) with 6 rules to follow during surgery.AimTo assess the knowledge of SCP among European surgeons and their opinion on its usefulness.Material and methodsData were gathered using questionnaires during surgical conferences in Poland and Denmark. The questionnaire asked about the surgeon’s experience in cholecystectomy and the number of complications in the form of CBDI. It asked about the surgeon’s opinion on the usefulness of SCP rules on a 10-point scale. A comparison between specialists and residents was performed. The study has been registered in the ClinicalTrials.gov – NCT03155321.ResultsOne hundred eighty-four questionnaires were gathered. One hundred fourteen (61.96%) specialists (72.8% male, mean age: 50 years) and 70 (38.04%) residents (56% male, mean age: 34 years) completed the questionnaire. Mean work experience was 22 years among specialists and 4.5 years among residents. A high percentage of specialists have experienced CBDI (46% vs. 17% of residents, p = 0.014). More specialists are familiar with the SCP than residents (49.3% vs. 21.7%, p = 0.021). Significant differences in the mean usefulness score were observed for three rules: rules 2 and 6 were found more useful by residents (mean score: 7.07 vs. 6.01, p = 0.025 and 8.70 vs. 8.27, p < 0.001), and rule 3 was found more useful by specialists (mean: 8.73 vs. 8.36, p < 0.001).ConclusionsThe awareness of the SCP in Europe is low. Participants consider the rules of the SCP to be useful during surgery, although there are differences in the usefulness scores between the groups. An educational program to promote and further implement the SCP should be established.

Clinical outcomes of robotic cholecystectomy: single center early experience

Introduction: Laparoscopic cholecystectomy is the gold-standard approach for gallbladder diseases. Recently, the robotic platform including single port has been released, which could technically facilitate cholecystectomy. Therefore, we report our early experience in robotic cholecystectomy at Chonbuk national medical. Method: From September 2017 to November 2018, all consecutive patients(n=72) who underwent robotic cholecystectomy were retrospectively analyzed. Variables of interest for this study were patient demographics, operative times for the procedure and morbidities. Result: Among 72 patients, the mean age was 43.4 years with range of 15-68 years. The male (n=26) to female (n=46) ratio was 1:1.8. The indication of cholecystectomy were stone in 57 cases and polyp in 15 cases. Single incision and 3-port robotic cholecystectomy were performed 59 and 13 cases, respectively. The mean docking and operating times were 8.6 and 83 mins. Total numbers of open or laparoscopic conversion are 2 cases due to sever adhesion. Postoperative complication was shown cholangitis in 1 case. (Clavien-Dindo classification grade 2) Conclusion: In our results, robotic cholecystectomy was shown feasible and safe procedures.

Surgical Simulation: Markers of Proficiency

Surgical simulation has become an integral component of surgical training. Simulation proficiency determination has been traditionally based upon time to completion of various simulated tasks. We aimed to determine objective markers of proficiency in surgical simulation by comparing novel assessments with conventional evaluations of technical skill. Categorical general surgery residents completed 10 laparoscopic cholecystectomy modules using a high-fidelity simulator. We recorded and analyzed simulation task times, as well as number of hand movements, instrument path length, instrument acceleration, and participant affective engagement during each simulation. Comparisons were made to Objective Structured Assessment of Technical Skill (OSATS) and Accreditation Council for Graduate Medical Education Milestones, as well as previous laparoscopic experience, duration of laparoscopic cholecystectomies performed by participants, and postgraduate year. Comparisons were also made to Fundamentals of Laparoscopic Surgery task times. Spearman's rho was utilized for comparisons, significance set at >0.50. University of Missouri, Columbia, Missouri, an academic tertiary care facility. Fourteen categorical general surgery residents (postgraduate year 1-5) were prospectively enrolled. One hundred forty simulations were included. The number of hand movements and instrument path lengths strongly correlated with simulation task times (ρ 0.62-0.87, p < 0.0001), FLS task completion times (ρ 0.50-0.53, p < 0.0001), and prior real-world laparoscopic cholecystectomy experience (ρ -0.51 to -0.53, p < 0.0001). No significant correlations were identified between any of the studied markers with Accreditation Council for Graduate Medical Education Milestones, Objective Structured Assessment of Technical Skill evaluations, total previous laparoscopic experience, or postgraduate year level. Neither instrument acceleration nor participant engagement showed significant correlation with any of the conventional markers of real-world or simulation skill proficiency. Simulation proficiency, measured by instrument and hand motion, is more representative of simulation skill than simulation task time, instrument acceleration, or participant engagement.

Mo1456 Laparoscopic Surgery Fellowship and Senior Surgeon Mentoring: Necessities in Era of Limited Open Cholecystectomy Experience During General Surgery Residency

Mo1456 Laparoscopic Surgery Fellowship and Senior Surgeon Mentoring: Necessities in Era of Limited Open Cholecystectomy Experience During General Surgery Residency

Residents' performance in open versus laparoscopic bench-model cholecystectomy in a hands-on surgical course

IntroductionLaparoscopy has become the gold standard for many abdominal procedures. Among young surgeons, experience in laparoscopic surgery increasingly outweighs experience in open surgery. This study was conducted to compare residents' performance in laparoscopic versus open bench-model task. MethodsIn an international surgical skills course, we compared trainees' performance in open versus laparoscopic cholecystectomy in a cadaveric animal bench-model. Both exercises were evaluated by board-certified surgeons using an 8-item checklist and by the trainees themselves. Results238 trainees with a median surgical experience of 24 months (interquartile range 14–48) took part. Twenty-two percent of the trainees had no previous laparoscopic and 62% no previous open cholecystectomy experience. Significant differences were found in the overall score (median difference of 1 (95% CI: 1, 1), p < 0.001), gallbladder perforation rate (73% vs. 29%, p < 0.001), safe dissection of the Calot's triangle (98% vs. 90%, p = 0.001) and duration of surgery (42 (13) minutes vs. 26 (10) minutes (mean differences 17.22 (95% CI: 15.37, 19.07), p < 0.001)), all favouring open surgery. The perforation rate in open and laparoscopic cholecystectomies was not consistently decreasing with increasing years of experience or number of previously performed procedures. Self-assessment was lower than the assessment by board-certified surgeons. ConclusionDespite lower experience in open compared to laparoscopic cholecystectomy, better performance was observed in open task. It may be explained by a wider access with easier preparation. Open cholecystectomy is the rescue manoeuvre and therefore, it is important to provide also enough training opportunities in open surgery.