title: The Effect of Afternoon Operative Sessions of Laparoscopic Cholecystectomy Performed by Senior Surgeons on the General Surgery Residency Program: A Comparative Study.
abstract: OBJECTIVE
  Laparoscopic cholecystectomy (LC) has been the gold standard for surgical treatment of gallbladder disease since 1980. This laparoscopic surgical procedure is one of the first to be performed by general surgery residents. There is a learning curve required to excel at performing LC. During this period, the operation needs to be performed under the supervision of a senior surgeon. The purpose of this study was to compare LC performed by residents with that performed by senior surgeons using the following parameters: operative time, conversion rate, complication rate, and mean length of hospital stay.
  
  
  METHODS
  This retrospective study included 1219 patients who underwent elective LC in our institute-788 operated on by a senior surgeon and 431 by a resident.
  
  
  RESULTS
  The mean operative time was 39 ± 19 minutes. There was a significant difference between the groups, as the mean operative time for the resident group was 49.9 ± 13 compared with 33.7 ± 6 for the senior surgeon group. The overall conversion rate was 2.1%, the complication rate was 2.2%, and the mean length of hospital stay was 1.5 days. There were no statistically significant differences between the groups for these parameters.
  
  
  CONCLUSIONS
  The only significant difference between the groups was a longer operative time, as the conversion rate, complication rate, and mean length of stay were the same. Therefore, it is safe for LC to be performed by residents supervised by a senior surgeon.
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Lavy
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel. Electronic address: fredricag@asaf.health.gov.il.
authors.forename: Ariel
authors.initials: A
authors.lastname: Halevy
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Hershkovitz
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; duration of surgical procedures; laparoscopic cholecystectomy; operative residency program; teaching setup