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 revieived 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 61%. Currently, 12% 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.