Technical aspects, safety, and learning curve of laparoscopic cholecystectomy using a reusable bipolar clamp: a risk-adjusted cusum analysis of 780 cases operated by surgical trainees

Introduction: Laparoscopic cholecystectomy (LC) is a common procedure and a key component of surgical training. However, balancing resident education with patient safety remains a challenge. While monopolar electrocautery is traditionally used, the reusable bipolar clamp (BiClamp) may offer advantages, though its role in LC has not been fully evaluated.

Aim: This study aimed to assess the technical aspects, safety, and learning curve associated with a standardized LC technique using the BiClamp, performed by surgical residents.

Methods: A total of 780 consecutive LCs performed by seven surgical residents from 2018 to 2024 were retrospectively analyzed. Only residents without prior LC experience were included. All relevant perioperative outcomes were evaluated. Learning curves were assessed using CUSUM and risk-adjusted CUSUM (RA-CUSUM) analyses based on operation time (OT) and surgical failures, defined as extended OT, intraoperative complications, or conversion to open surgery.

Results: No intraoperative biliary or vascular injuries occurred. Conversion to open surgery was necessary in only 0.3% of cases. The overall mean OT was 57.2±16.5 minutes and surgical failure occurred in 10.6% of cases. The learning phase lasted 8–18 procedures, with proficiency reached after 21–97 cases. RA-CUSUM analyses confirmed performance improvements despite increasing case complexity.

Conclusion: LC using the BiClamp is a safe and effective technique for surgical training, with a relatively short learning curve. These findings support its integration into standardized LC protocols for residents, though further multicenter validation is warranted ([Fig. 1] [2] [3]).

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