Training Background as a Factor in the Conversion Rate of Laparoscopic Cholecystectomy

Ayerdi, Juan; Wiseman, Jeffrey; Gupta, Sushil K.; Simon, Steven C.
August 2001
American Surgeon;Aug2001, Vol. 67 Issue 8, p780
Academic Journal
The present study reports findings concerning the impact of the learning environment on the conversion rate of laparoscopic cholecystectomy (LC) to open cholecystectomy (OC). At MetroWest Medical Center (Framingham, MA) seven surgeons performed 866 LCs between 1990 and 1995. Group I consisted of three surgeons who learned the procedure as part of their General Surgery Residency training, whereas the remaining four surgeons representing Group II learned the procedure through private courses. We emphasize the importance of the surgeons' training background on the conversion rates, operative times, and length of hospitalization for patients undergoing LC. The conversion rates, operative times, and complication rates were analyzed with and without a 2-year period of adjustment to compensate for the learning curve of early procedures. Operative times and conversion rates from LC to OC were lower for cases done by surgeons from Group I, even when the learning curve was corrected. The complication rates were higher for surgeons in Group II, but this did not reach statistical significance. As surgeons from Group II gained more experience their operation times and conversion rates decreased. However, there still was a statistically significant difference in favor of surgeons who learned the procedure as part of a structured curriculum. These data suggest a long-lasting influence of the learning environment on the conversion rates and operative times.


Related Articles

  • Fibrinolytic Activity in Laparoscopic Cholecystectomy. Martinez-Ramos, C.; Lopez-Pastor, A.; Nunez-Pena, J.R.; Ruiz-Caravaca, M.L.; Ruiz de Gopegui, M.; Sanz-Lopez, R.; Jorgensen, T.W.; Tamames-Escobar, S. // Journal of Laparoendoscopic & Advanced Surgical Techniques;Dec98, Vol. 8 Issue 6, p417 

    Focuses on a study which examined the fibrinolytic activity in laparoscopic cholecystectomy (LC) to determine whether changes occur that might indicate a greater risk of thrombosis. Information on some complications caused by LC; Materials and methods used; Results and discussion.

  • Laparoscopic Cholecystectomy: Survey of Complications.  // American Family Physician;7/1/1993, Vol. 48 Issue 1, p117 

    Summarizes the article `Laparoscopic Cholecystectomy: Survey of Complications,' by Deziel and colleagues in the `American Journal of Surgery,' dated January 1993. Survey; Kinds of surgical complications; Morbidity and mortality.

  • Laparoscopic Cholecystectomy: Retrospective Comparative Evaluation of Titanium versus Absorbable Clips. Bencini, Lapo; Boffi, Bernardo; Farsi, Marco; Sanchez, Luis Josè; Scatizzi, Marco; Moretti, Renato // Journal of Laparoendoscopic & Advanced Surgical Techniques;Apr2003, Vol. 13 Issue 2, p93 

    We present a retrospective study of the use of titanium and absorbable clips during laparoscopic cholecystectomy. The aim was to determine any differences in outcome and costs. From January 1999 to February 2002, 690 patients who had successfully undergone a laparoscopic cholecystectomy were...

  • Conversion Rate in Laparoscopic Cholecystectomy: Evolution from 1993 and Current State. Capizzi, Francesco Domenico; Fogli, Luciano; Brulatti, Mauro; Boschi, Sergio; Di Domenico, Marco; Papa, Vito; Patrizi, Patrizio // Journal of Laparoendoscopic & Advanced Surgical Techniques;Apr2003, Vol. 13 Issue 2, p89 

    The definition of difficult laparoscopic cholecystectomy (LC) is inconsistent. The aim of this study was to analyze the factors that make LC difficult to perform and determine ways to avoid conversion, based on our series. All patients who underwent LC or open cholecystectomy (OC) between...

  • The laparoscopic approach reduces the endocrine response to elective cholecystectomy. Schauer, Philip R.; Sirinek, Kenneth R. // American Surgeon;Feb1995, Vol. 61 Issue 2, p106 

    Presents a study which evaluates and compares the effect of methods of laparoscopic versus open surgical techniques on the stress of elective cholecystectomy by measuring the neuroendocrine response. Reduced neuroendocrine response to surgical trauma following cholecystectomy as a result of the...

  • Missed pathology following laparoscopic cholecystectomy: A cause for concern? Denning, D.A.; Lipshy, Kenneth A. // American Surgeon;Feb1995, Vol. 61 Issue 2, p117 

    Evaluates the first two years of laparoscopic cholecystectomy in a community to examine the frequency of intra-abdominal pathology that may have been overlooked. Percentage of patients with `missed pathology' who were readmitted for a carcinomas; Other diseases reported; Possibility that in the...

  • Common duct exploration during laparoscopic cholecystectomy. Fallahzadeh, Hossein // American Surgeon;Feb1997, Vol. 63 Issue 2, p121 

    Debates the best way to manage common duct stones suspected preoperatively or discovered on cholangiography during laparoscopic cholecystectomy. Surgeons' reliance on endoscopic retrograde cholangiography (ERC) with sphincterotomy (S); Cases of cholecystectomies.

  • Surgical Rates and Operative Mortality for Open and Laparoscopic Cholecystectomy in Maryland. Steiner, Claudia A.; Bass, Eric B.; Talamini, Mark A.; Pitt, Henry A.; Steinberg, Earl P. // New England Journal of Medicine;2/10/94, Vol. 330 Issue 6, p403 

    Background: Since 1989, laparoscopic cholecystectomy has been widely adopted as a treatment for gallstone disease. We analyzed the association between the introduction of this procedure and three variables: the rate at which cholecystectomy was performed in Maryland, the characteristics of...

  • All about laparoscopic removal of your gallbladder.  // American Family Physician;12/1/1994, Vol. 50 Issue 8, p1714 

    Offers information on laparoscopic cholecystectomy. Use of a laparoscope; Removal of the gallbladder; Comparison with open cholecystectomy; Complications.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics