Clinical strategies to aim an adequate safety profile for patients and effective training for surgical residents: The laparoscopic cholecystectomy model

Abstract

BackgroundTraining programs for resident surgeons represent a challenge for the mentoring activity. The aim of the present study is to investigate the impact of our training program for laparoscopic cholecystectomy on patient's safety and on the modulation of the residents' exposure to clinical scenario with different grades of complexity.Material and methodsThis is a retrospective study based on a clinical series of laparoscopic cholecystectomy performed in a teaching hospital. Study population was grouped according to the expertise of the attending primary operator among resident surgeons. Four groups were identified: consultant (C), senior resident (SR); intermediate level resident (IR); junior resident (JR). The intraoperative and postoperative outcomes were confronted to evaluate the patient's safety profile.Results447 patients were submitted to LC: 96 cases were operated by a C, 200 by SR, 112 by IR and 39 by JR. The mean operative time was the longest for the JR group. A statistically higher rate of conversion to open approach was registered in C and IR groups in comparison to JR and SR groups. However, in C and IR groups, patients had worse ASA score, higher BMI and more frequent past history of previous abdominal surgery, cholecystitis or pancreatitis. Overall, it was not registered any statistically significant difference among the groups in terms of length of hospital stay and prevalence of major postoperative complications.ConclusionApplying an educational model based on both graduated levels of responsibility and modulated grade of clinical complexity can guarantee an high safety profile.

The Impact of a Surgical Unit’s Structure and Operative Technique on Quality in Two Swedish Rural Hospitals

“…Since the duration of the operation is dependent on the individual surgeon's training and expertise [4,[8][9][10], the difference in structure of the surgical units is an important aspect to consider when discussing the difference in operative time [3,4]. Most of the LCs in Sundsvall are performed by a UGI specialist or in the presence of a UGI specialist.…”

“…general surgeon), which could prolong the surgery time because they have less specific procedure experience. Furthermore, some of the operations at both clinics are performed by residents and the structured surgical training in Sundsvall might improve the learning curve for the residents (and also make them better trained when they become specialists), which could affect the outcome of the operation and decrease the operative time for them as compared to € Ostersund trained residents [8][9][10][11]. Additionally, the logistics within the operating room for the two surgical units might differ.…”

“…Thus, surgical residents and specialists must develop laparoscopic skills. There are indications that a more structured education, as well as a refined operative technique, leads to higher quality of care for the patients as well as a more efficient use of healthcare resources [8]. Several studies have also recognized the importance of incorporating simulator training in the curriculum, as this improved both learning and outcomes [8][9][10][11][12] without compromising safety [10].…”

Predictive Factors for Drain Placement After Laparoscopic Cholecystectomy

“…In our center, LC has been performed according to a standardized technique (19). The patient is positioned in stirrups with the primary operator standing between the legs.…”

Laparoscopic cholecystectomy performed by general surgery residents. Is it safe? How much does it cost?

“…On the other hand, the laparoscopic approach has become the standard for many types of operations and is routinely performed, even in smaller hospitals 3 .…”