The effect of residents as teaching assistants on operative time in laparoscopic cholecystectomy.
BACKGROUND
We examined the effect of primary surgeon (PS) and teaching assistant (TA) seniority on operative time and outcomes for residents performing laparoscopic cholecystectomy (LC).


METHODS
This was a retrospective analysis of urgent LC at a county teaching hospital. Relevant data included postgraduate year (PGY) of the PS and TA and markers of disease severity. Primary outcome was operative time. Secondary outcomes were conversion to open cholecystectomy and complications.


RESULTS
There were 1,202 LCs; 415 included an intraoperative cholangiogram. On multivariable analysis, every PGY increase of PS decreased operative time by 3.2 minutes (P = .02). For every PGY increase of TA, operative time decreased 10.8 minutes (P < .001). Acute or gangrenous pathology increased conversion to open surgery (P < .001). Seniority of PS and TA was not associated with increases in conversion or complication rates.


CONCLUSIONS
Residents' operative time improves as experience with LC increases. These improvements become more profound after adjusting for the seniority of the TA.
Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 25, Torrance, CA 90502, USA.
Edward
E
Gifford
Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 25, Torrance, CA 90502, USA.
Dennis Y
DY
Kim
Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 25, Torrance, CA 90502, USA.
Andrew
A
Nguyen
Harbor-UCLA Medical Center, Torrance, CA, USA.
Amy H
AH
Kaji
Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 25, Torrance, CA 90502, USA.
Virginia
V
Nguyen
Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 25, Torrance, CA 90502, USA.
David S
DS
Plurad
Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 25, Torrance, CA 90502, USA. Electronic address: cdevirgilio@labiomed.org.
Christian
C
de Virgilio
D000328:Adult; D002140:California; D017081:Cholecystectomy, Laparoscopic / Q000193:education* / Q000706:statistics & numerical data; D002983:Clinical Competence; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D059032:Learning Curve; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies
Laparoscopic cholecystectomy; Operative time; Resident education; Teaching assistant