Adverse outcome from LC is particularly associated with male gender, but also the patient's co-morbidity, complexity and urgency of surgery. Risk-adjusted outcome analysis is desirable to ensure an informed consent process.
ProMIS provides a construct valid laparoscopic simulator and is a feasible tool to assess skills in a cross-section of surgical experience groups. ProMIS has the potential to objectively measure pre-theatre dexterity practice until an agreed proficiency level of dexterity is achieved. Future work should now examine whether training to expert criterion levels on ProMIS correlates with actual operative performance.
Laparoscopic bile duct exploration can be performed successfully in both the emergency and elective settings. Day-case surgery is feasible in selected patients. A transcystic approach should be favoured where possible.
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