Background and Study Aims: Since the introduction of laparoscopic cholecystectomy (LC), numerous articles have
been written emphasising its many advantages over open cholecystectomy (OC). However,
reports also highlight increased complications following LC such as bile-duct, vascular
and bowel injuries. We aimed to study surgical trainees as a defined population of
individuals who, with increasing exposure to cholecystectomy, would become fully aware
of LC’s advantages and controversies. We wished to test the hypothesis that, with
increasing in-depth knowledge, they might opt for OC rather than LC if they themselves
required cholecystectomy.
Materials and Methods: We conducted a postal survey of all 133 Northern Ireland surgical trainees identified
as having exposure to LC during their training. Trainees were asked whether they would
undergo LC and if so with which preconditions. Similarly, if they stated a preference
for open cholecystectomy they were asked to state the reason. A minimum time period
of 18 months was considered adequate for trainees to become relatively more experienced
in this field compared with their more junior counterparts.
Results: A response rate of 80.5 % (107/133) was achieved. A total of 51 of 107 trainees had
at least 18 months’ experience. Of the 107 who replied, 88.8 % (95/107) would be willing
to undergo LC. A total of 12 of 107 trainees would opt for OC, with twice as many
experienced trainees (8 vs. 4) opting for this approach (n. s. [not significant]).
Significantly more experienced trainees cited the use of laparoscopic cholangiography
as a precondition for LC compared with their inexperienced counterparts (7 vs. 1,
p = 0.020). Of 107 trainees, 19 would request use of the open first port (Hasson)
technique; 14 of these had at least 18 months’ experience (p = 0.009).
Conclusion: Our survey confirms that the majority of trainees would be willing to undergo LC.
However, increased experience of LC may alter an individual's expectations about how
LC should ideally be performed.
References
- 1
Dunn D, Nair R, Fowler S, McCloy R.
Laparoscopic cholecystectomy in England and Wales: results of an audit by the Royal
College of Surgeons of England.
Ann R Coll Surg Engl.
1994;
76 (4)
269-275
- 2
Kent P, Bannon C A, Beausang O, et al.
The introduction of laparoscopic cholecystectomy - audit of transition period with
late follow-up.
Ir J Med Sci.
1995;
164 (1)
1-3
- 3
Torkington J, Pereira J, Chalmers R T, Horner J.
Laparoscopic cholecystectomy, bile duct injury and the British and Irish surgeon.
Ann R Coll Surg Engl.
1998;
80 (2)
119-121
- 4
Richardson M C, Bell G, Fullarton G M.
Incidence and nature of bile duct injuries following laparoscopic cholecystectomy:
an audit of 5913 cases. West of Scotland Laparoscopic Cholecystectomy Audit Group.
Br J Surg.
1996;
83 (10)
1356-1360
- 5
Savader S J, Lillemoe K D, Prescott C A, et al.
Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster.
Ann Surg.
1997;
225 (3)
268-273
- 6
Adamsen S, Hansen O H, Funch-Jensen P, et al.
Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series.
J Am Coll Surg.
1997;
184 (6)
571-578
- 7
Targarona E M, Marco C, Balague C, et al.
How, when, and why bile duct injury occurs. A comparison between open and laparoscopic
cholecystectomy.
Surg Endosc.
1998;
12 (4)
322-326
- 8
Parks R W, Spencer E FA, McIlrath E M, Johnston G W.
A review of the management of bile duct injuries.
Ir J Med Sci.
1994;
163 (12)
571-575
- 9
Bingham J, McKie L D, et al.
Biliary complications associated with laparoscopic cholecystectomy: analysis of common
misconceptions.
Br J Surg.
2000;
87 (3)
362-373
- 10
Steele R J, Marshall K, Lang M, Doran J.
Introduction of laparoscopic cholecystectomy in a large teaching hospital: independent
audit of the first 3 years.
Br J Surg.
1995;
82 (7)
968-971
- 11
Nair R G, Dunn D C, Fowler S, McCloy R F.
Progress with cholecystectomy: improving results in England and Wales.
Br J Surg.
1997;
84 (10)
1396-1398
- 12
Yerdel M A, Karayalcin K, Koyunca A, et al.
Direct trocar insertion versus Veress needle insertion in laparoscopic cholecystectomy.
Am J Surg.
1999;
177 (3)
247-249
- 13
Peitgen K, Nimtz K, Hellinger A, Walz M K.
Open approach or Verress needle in laparoscopic interventions? Results of a prospective
randomized controlled study (in German).
Chirurg.
1997;
68 (9)
910-913
- 14
Chitre V V, Studley J G.
Audit of methods of laparoscopic cholecystectomy.
Br J Surg.
1999;
86 (9)
185-188
- 15
Stuart S A, Simpson T I, Alvord L A, Williams M D.
Routine intraoperative laparoscopic cholangiography.
Am J Surg.
1998;
176 (6)
632-637
- 16
Keeling N J, Menzies D, Motson R W.
Laparoscopic exploration of the common bile duct: beyond the learning curve.
Surg Endosc.
1999;
13 (2)
109-112
- 17
Mjaland O, Adamsen S, Hjelmquist B, et al.
Cholecystectomy rates, gallstone prevalence, and handling of bile duct injuries in
Scandinavia. A comparative audit.
Surg Endosc.
1998;
12 (12)
1386-1389
R. C. Baker, M.D., F.R.C.S.
c/o D. McCrory, M.D.
Whiteabbey Hospital
Doagh Road
Newtownabbey
Belfast BT37 9RH
N. Ireland
Fax: Fax:+ 44-2890-552621
Email: E-mail:robincbaker@hotmail.com
