Single Incision Laparoscopic Cholecystectomy: a Combined Analysis of Resident and Attending Learning Curves At a Single Institution
Mark Joseph*, Michael Phillips, Christopher C. Rupp
Department of Surgery, University of North Carolina, Chapel Hill, NC
Introduction: Single Incision Laparoscopic Cholecystectomy (SILC) is a recent technical modification on standard laparoscopic cholecystectomy that has been shown to be safe and feasible. Studies to date have focused on determining the role of SILC in modern surgery. Recent studies suggest that experienced laparoscopic surgeons have a short learning curve to become proficient in SILC. However, little is known about the interaction of the learning curves of residents and attending surgeons at academic teaching programs. Method: We prospectively evaluated various metrics of both attending and resident surgeons as they progressed in their experience with SILC. Patients were placed into cohorts of 25 based on teaching surgeon experience. Data recorded included patient specific variables as well as operative variables, complications, conversions to standard laparoscopic cholecystectomy, and outcomes.Results: 101 patients underwent SILC. 17% of patients required conversion to standard laparoscopic cholecystectomy. No significant difference was found in operative times between that of standard laparoscopic cholecystectomy, as well as within the experience-based cohorts (p = 0.152). There was an overall increase in operative time and the number of ports needed in patients with acute cholecystitis and gallstone pancreatitis, but this did not reach statistical significance. A reduction in operative time was shown in residents who were proficient in standard laparoscopic cholecystectomy in terms of a learning curve. Operative times remained the same for the teaching surgeon regardless of experience of resident surgeon. Operative and outcome data were similar between SILC and standard laparoscopic cholecystectomy. Conclusion: SILC has a short learning curve for resident surgeons who are proficient in standard laparoscopic surgery. SILC can be effectively taught with few complications and outcomes similar to standard laparoscopic cholecystectomy. Attending surgeons, although in a teaching operative role, can preserve operative efficiency and safety while training resident surgeons in SILC.
Operative times of patient cohorts versus teaching surgeon experience.
| Operative times (minutes) | Cohort 1 (Patients 1-24) | Cohort 2 (Patients 25-49) | Cohort 3 (Patients 50-74) | Cohort 4 (Patients 75-101) |
| 85 | 67 | 75 | 75 |
Each cohort represents 25 patients.
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