The effect of laparoscopic cholecystectomy on resident training.

BACKGROUND

The purpose of this study was to determine the impact of laparoscopic cholecystectomy (LC) on resident training.

MATERIALS AND METHODS

We reviewed our experience over an 11-year period, from academic years 1982 to 1992, with 3,046 patients who underwent elective open cholecystectomy (OC) and 640 patients who underwent LC.

RESULTS

Prior to LC, junior residents performed 80% of all cholecystectomies, with a morbidity and mortality rate of 4% and 0.04%, respectively, compared with 11% and 0.3%, respectively, for senior residents who operated on higher-risk patients. Since the introduction of the technique, there has been a 25% increase in cholecystectomies per year, and a reduction in junior resident OC experience by 67%. Currently, 72% of all cholecystectomies are performed laparoscopically by senior residents.

CONCLUSION

The replacement of OC by LC has produced a qualitative change in the operative experience of our junior residents and a delay in acquisition of operative skills. The reduction in OC experience by residents may jeopardize their ability to perform the difficult open cases.