The Learning Curve for Laparoscopic Cholecystectomy

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Abstract
The introduction of laparoscopic cholecystectomy (LC) in 1987 has resulted in its wide acceptance by surgeons in the United States. Questions about proper training and learning curve for surgeons wishing to perform laparoscopic procedures have been raised during this period. We retrospectively evaluated 416 consecutive cholecystectomy cases that were performed by eight surgeons in a community teaching hospital. In this report, 374 patients had LC and 42 patients (10%) had an attempted LC, which had to be converted to an open cholecystectomy (CONV). Surgeons A and B performed 40% and 18% of all LC cases, respectively, and were classified as the surgeons with the highest volume of cases. Parameters, including conversion rate, operative time, and complications, were evaluated to define the learning curve. Surgeons A and B experienced 17% and 14% initial conversion rates for the first 35 cases, respectively. These rates dramatically dropped to an acceptable level (4% and 3%) with increased experience. The operative time for surgeon A for the first and last 35 cases improved from 97 ± 25 min to 74 ± 32 min (p = 0.01). Although the procedure time for surgeon B improved by 4 min, this difference was not statistically significant. The operative time for all cases was 81 ± 31 min and 87 ± 27 min, respectively, for surgeons A and B, which was significantly less than that for other surgeons (p = 0.01). A total of 12 patients experienced complications related to LC. Most of the complications (75%) occurred in the first 30 cases for all surgeons. Analysis of our data reveals that there is a long learning curve for LC, as evidenced by conversion rates, operative time, and complication rates. We, therefore, conclude that LC has a definable learning curve and is a safe procedure with proper training.

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