Impact of laparoscopic cholecystectomy on surgical training.

All cholecystectomies in a single health district were studied during a 5-year period spanning the introduction of laparoscopic cholecystectomy (LC). The number of LCs increased from 2 (1.3%) in year 3 to 86 (56%) in year 5. The number of operative cholangiograms and explorations of the common bile duct performed both fell substantially. The age distribution did not change significantly during the study period, but the percentage of females undergoing cholecystectomy increased. The percentage of trainee operations remained constant in those Firms performing only open cholecystectomy (OC), but fell from 67% to 9% in those adopting LC. An increase in annual cholecystectomy rate was seen with the laparoscopic surgeons, with a corresponding fall for those surgeons performing only OC. There was a threefold increase in the percentage of operations performed privately from years 2 to 5, with 73% being laparoscopic in year 5. The consequences for training of the introduction of LC must be addressed.