title: Impact of seniority on operative time and short-term outcome in laparoscopic cholecystectomy: Experience of an academic Surgical Department in a developing country.
abstract: BACKGROUND
  Resident participation in laparoscopic cholecystectomy (LC) is one of the first steps of laparoscopic training. The impact of this training is not well-defined, especially in developing countries. However, this training is of critical importance to monitor surgical teaching programmes.
  
  
  OBJECTIVE
  The aim of this study was to determine the impact of seniority on operative time and short-term outcome of LC.
  We performed a retrospective study of all consecutive laparoscopic cholecystectomies for gallbladder lithiasis performed over 2 academic years in an academic Surgical Department in Morocco.
  
  
  METHODS
  These operations were performed by junior residents (post-graduate year [PGY] 4-5) or senior residents (PGY 6), or attending surgeons assisted by junior residents, none of whom had any advanced training in laparoscopy. All data concerning demographics (American Society of Anesthesiologists, body mass index and indications), surgeons, operative time (from skin incision to closure), conversion rate and operative complications (Clavien-Dindo classification) were recorded and analysed. One-way analysis of variance, Student's t-test and Chi-square tests were used as appropriate with statistical significance attributed to P < 0.05.
  
  
  RESULTS
  One hundred thirty-eight LC were performed. No differences were found on univariate analysis between groups in demographics or diagnosis category. The overall rate of operative complications or conversions and hospital stay were not significantly different between the three groups. However, mean operative time was significantly longer for junior residents (n = 27; 115 ± 24 min) compared to senior residents (n = 37; 77 ± 35 min) and attending surgeons (n = 66; 55 ± 17 min) (P < 0.001).
  
  
  CONCLUSIONS
  LC performed by residents appears to be safe without a significant difference in complication rate; however, seniority influences operative time. This information supports early resident involvement in laparoscopic procedures and also the need to develop cost-effective laboratory training programmes.
authors.affiliation: Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco.
authors.forename: Amine
authors.initials: A
authors.lastname: Souadka
authors.affiliation: Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco.
authors.forename: Mohammed Sayed
authors.initials: MS
authors.lastname: Naya
authors.affiliation: Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco.
authors.forename: Badr
authors.initials: B
authors.lastname: Serji
authors.affiliation: Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco.
authors.forename: Hadj Omar
authors.initials: HO
authors.lastname: El Malki
authors.affiliation: Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco.
authors.forename: Raouf
authors.initials: R
authors.lastname: Mohsine
authors.affiliation: Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco.
authors.forename: Lahsen
authors.initials: L
authors.lastname: Ifrine
authors.affiliation: Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco.
authors.forename: Abdelkader
authors.initials: A
authors.lastname: Belkouchi
authors.affiliation: Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco.
authors.forename: Amine
authors.initials: A
authors.lastname: Benkabbou