Residents' performance in open versus laparoscopic bench-model cholecystectomy in a hands-on surgical course.
BACKGROUND
Laparoscopy has become the gold standard for many abdominal procedures. Among young surgeons, experience in laparoscopic surgery increasingly outweighs experience in open surgery. This study was conducted to compare residents' performance in laparoscopic versus open bench-model task.


METHODS
In an international surgical skills course, we compared trainees' performance in open versus laparoscopic cholecystectomy in a cadaveric animal bench-model. Both exercises were evaluated by board-certified surgeons using an 8-item checklist and by the trainees themselves.


RESULTS
238 trainees with a median surgical experience of 24 months (interquartile range 14-48) took part. Twenty-two percent of the trainees had no previous laparoscopic and 62% no previous open cholecystectomy experience. Significant differences were found in the overall score (median difference of 1 (95% CI: 1, 1), p < 0.001), gallbladder perforation rate (73% vs. 29%, p < 0.001), safe dissection of the Calot's triangle (98% vs. 90%, p = 0.001) and duration of surgery (42 (13) minutes vs. 26 (10) minutes (mean differences 17.22 (95% CI: 15.37, 19.07), p < 0.001)), all favouring open surgery. The perforation rate in open and laparoscopic cholecystectomies was not consistently decreasing with increasing years of experience or number of previously performed procedures. Self-assessment was lower than the assessment by board-certified surgeons.


CONCLUSIONS
Despite lower experience in open compared to laparoscopic cholecystectomy, better performance was observed in open task. It may be explained by a wider access with easier preparation. Open cholecystectomy is the rescue manoeuvre and therefore, it is important to provide also enough training opportunities in open surgery.
Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland. Electronic address: christian.nebiker@usb.ch.
Christian Andreas
CA
Nebiker
Department of Surgery, Hospital of Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland. Electronic address: robert.mechera@ksbl.ch.
Robert
R
Mechera
Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland. Electronic address: rachel.rosenthal@unibas.ch.
Rachel
R
Rosenthal
Basel Institute for Clinical Epidemiology and Biostatistics, Hebelstrasse 10, 4056 Basel, Switzerland. Electronic address: sarah.thommen@usb.ch.
Sarah
S
Thommen
Department of General Surgery, Hospital of Aarau, Tellstrasse, 5000 Aarau, Switzerland. Electronic address: walter.r.marti@ksa.ch.
Walter Richard
WR
Marti
Indiana University School of Medicine South Bend, Indiana University Health Goshen Center for Cancer Care, Goshen, IN, USA. Electronic address: uvonholzen@iuhealth.org.
Urs
U
von Holzen
Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland. Electronic address: daniel.oertli@usb.ch.
Daniel
D
Oertli
Department of Surgery, Hospital of Dornach, Spitalweg 11, 4143 Dornach, Switzerland. Electronic address: peter.vogelbach@spital.so.ch.
Peter
P
Vogelbach
D000328:Adult; D000818:Animals; D002102:Cadaver; D002763:Cholecystectomy / Q000009:adverse effects / Q000193:education*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000193:education*; D002983:Clinical Competence; D003479:Curriculum; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D023421:Models, Animal; D055815:Young Adult
Bench-model; Open cholecystectomy; Surgical education; Training