Introduction: Standardized, efficient surgical training is increasingly confronted with the public demand for high quality of surgical care in modern teaching hospitals. The aim of this study was to compare perioperative morbidity and mortality of laparoscopic cholecystectomy (LC) as a highly standardized teaching operation when being performed by junior and senior surgical residents (SR) as opposed to those performed by attending surgeons (AS), in a hospital with high percentage of laparoscopic operations.Materials and
Methods: 1220 LC were performed in a university-affiliated Swiss community hospital between 1999 and 2006. There were 788 (65%) female and 432 (35%) male patients, with an average age of 55 years (range 16-93 years); 874 operations were performed electively, 346 cases were urgent operations. All LC performed by resident surgeons were assisted by attending surgeons or chief residents. Intraoperative cholangiography was routinely performed. Observed parameters were the duration of operation and of hospital stay, 30-day perioperative morbidity, mortality, and readmission rate. Results are stated as mean ± SEM, with p<0.05 defined as statistically significant.
Results: Overall length of operation was 92 ± 2 minutes for SR vs. 80 ± 2 minutes by AS (p<0.001). Elective operations were shorter (91 ± 2 [SR] vs. 76 ± 2 [AS] minutes, p<0.001) than urgent operations (96 ± 3 [SR] vs. 90 ± 3 [AS] minutes, p=0.3). Length of hospital stay was shorter in patients treated by SR as compared to those treated by AS (elective LC: 5.2 ± 0.3 days [SR] vs. 6.7 ± 0.2 days [AS], p<0.001; urgent LC: 6.8 ± 0.6 days [SR] vs. 8.2 ± 0.5 days [AS], p=0.1). Intraoperative complications occured in 4.2%, and were independent of surgeon’s experience. Bile duct lesions occurred in 0.2% of all patients. Conversion to an open cholecystectomy for technical difficulties was performed in 24 patients (1.9%). Thirty day morbidity was 8.7% in urgent LC versus 3.3% in elective LC (p<0.001). Overall mortality was 0.4% in elective LC and 1.9% in urgent LC (p>0.001), again independent of surgical expertise.
Discussion: Surgical residents are able to perform LC under appropriate supervision with results comparable to those of experienced surgeons. No differences could be detected with respect to perioperative morbidity or mortality; in particular, serious surgical complications such as bile duct injury are rare and are again independent of surgeon’s’ experience. A structured residency quality control program can improve the quality of surgical care and pinpoint weaknesses of surgical training at individual institutions.