title: Are we training our residents to perform open gall bladder and common bile duct operations?
abstract: BACKGROUND
  In the new era of resident work hour restrictions and an emphasis on minimally invasive surgery, experience in performing open biliary surgery is diminishing. We sought to review our resident operative experience to determine if it appears adequate for a well-trained general surgeon.
  
  
  METHODS
  The case logs of the General Surgery, Oncology, and Trauma/Emergency General Surgery (EGS) services were reviewed for a 1-year period. All biliary procedures that included the potential for gallbladder or bile duct surgery were reviewed.
  
  
  RESULTS
  We performed 745 laparoscopic cholecystectomies last year on our General Surgery, Oncology, and Trauma/EGS services. Conversion to open procedure was 4.5% (16/364) on our elective services and 6% (23/381) on our Trauma/EGS services. Effective clearance of common bile duct stones performed retrograde by endoscopy and transhepatically by interventional radiology limited our residents' experience performing common bile duct surgery for stones to 13 performed laparoscopically and 10 performed open. Other operations that included open cholecystectomies and common bile duct procedures were pancreatico-duodenectomy (87), biliary bypass (22), biliary resection/reconstruction (20), hepatic lobectomy (48), sphincteroplasty and ampullectomy (6).
  
  
  CONCLUSIONS
  The small number of conversions from laparoscopic to open cholecystectomies and the few common bile duct explorations performed for stone disease would be inadequate to train our six categorical surgical residents to perform open cholecystectomies and common bile duct procedures without a training program that augments this by providing a strong hepato-biliary-pancreatic experience. Programs without a strong hepato-biliary-pancreatic program should review their residents' operative experience.
authors.affiliation: DeWitt Daughtry Family Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida 33101, USA. carl@miami.edu
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
authors.forename: Joe
authors.initials: J
authors.lastname: Levi
authors.forename: Danny
authors.initials: D
authors.lastname: Sleeman
authors.forename: Brian
authors.initials: B
authors.lastname: Dunkin
authors.forename: George
authors.initials: G
authors.lastname: Irvin
authors.forename: David
authors.initials: D
authors.lastname: Levi
authors.forename: Seth
authors.initials: S
authors.lastname: Spector
authors.forename: Dido
authors.initials: D
authors.lastname: Franceschi
authors.forename: Alan
authors.initials: A
authors.lastname: Livingstone
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D002763:Cholecystectomy / Q000193:education* / Q000379:methods / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000193:education / Q000706:statistics & numerical data; D042882:Gallstones / Q000601:surgery*; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration / Q000706:statistics & numerical data* / Q000639:trends; D019060:Minimally Invasive Surgical Procedures / Q000193:education / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling