Laparoscopic cholecystectomy. The early experience of surgical attendings compared with that of residents trained by apprenticeship.

During our first year of laparoscopic surgery, all cases were performed by attending surgeons; resident involvement was confined to camera work and occasionally to acting as first assistant. These residents were PGY3 or -4. During our second year, these same residents, who had learned the craft in the traditional apprenticeship method, on promotion to senior resident functioned as the primary surgeon in laparoscopic cholecystectomy cases, but under very close guidance by the credentialed attending. Ninety-two cases were attempted in the first year and 100 in the second. There were no differences in age, gender, or preoperative symptoms. More than half the patients had at least one co-morbidity in addition to their gallbladder disease. More women had laparoscopic cholecystectomy soon after pregnancy in the second year, but the percent of the patients with previous surgery declined from 21.4% to 5%. There was a threefold increase in the percent of cases performed in less than two hours and there was a significant reduction in hospital length of stay in the second year. Complication rates were similar in the first and second years. Training residents to do laparoscopic cholecystectomy can be done in a traditional residency program provided the attendings are adequately trained. However, the residents need a higher level of skill at this time than was necessary for open cholecystectomy and have to be further advanced in their training in order to perform this operation laparoscopically.