Open Cholecystectomy for the New Learner—Obstacles and Challenges

Abstract

Background: Laparoscopy has become the standard of care in most general surgery procedures. This has led to a decrease in the number of open surgical procedures for surgical training, particularly as senior surgeons retire. The aim of this study was to evaluate the impact of retiring senior surgeons on our residents' operative experience.Methods: Cholecystectomies performed between Jan 2010 and Dec 2016 were retrospectively reviewed. Surgeons training residents were divided into two groups based on their training experience. Group 1 were trained in the prelaparoscopic era, and group 2 were trained during the age of laparoscopy. We then evaluated the impact of retirement on the number of open cholecystectomies performed.Results: There were 4555 laparoscopic cholecystectomies performed at our institution over a 7-year period. Overall conversion rate was 1.5% (66/4555). Conversion rates were higher in group 1 as compared to group 2. The analysis of the number of open cases performed by each graduating resident showed reduction in the number of open cholecystectomies performed over time. Conclusion:The decline in the number of open cholecystectomies creates a challenge for the training of general surgery residents. To compensate, we have employed simulation curriculum with the use of cadaveric surgical anatomy courses. Additionally, with transplant curriculum, open cholecystectomy experience has increased with liver transplant exposure. Continued laparoscopic experience has also shown that advanced laparoscopic techniques such as top down dissection laparoscopically have decreased the need for conversion to open and are skills that graduating residents possess.

Therapeutic Effect of Laparoscopic Cholecystectomy on Patients with Cholecystolithiasis Complicated with Chronic Cholecystitis and Postoperative Quality of Life

“…Chronic nonlithiatic cholecystitis is mainly caused by bacterial infections of enteric origin, where intestinal bacteria can pass through the bile duct to the gallbladder, or through the blood or lymphatic route to the gallbladder [ 22 ]. The treatment of patients with cholecystitis combined with gallstones was mostly performed by open surgery previously [ 23 ], which could achieve satisfactory therapeutic results but is associated with disadvantages such as significant trauma, long operative time, large intraoperative blood volume, and a negative impact on patients' gastrointestinal function [ 24 ]. In recent years, laparoscopic cholecystectomy has been widely used in the clinical treatment of patients with chronic cholecystitis and gallbladder stones [ 25 , 26 ].…”

Subtotal Cholecystectomy Results in High Peri‐operative Morbidity and Its Risk‐Profile Should be Emphasised During Consent

“…Whilst one may expect leaving posterior gallbladder wall in situ would precipitate further problems, post-operative morbidity is not higher in these cases and leaving the wall in situ avoids further complication (e.g. liver injury, significant haemorrhage) [ 9 , 22 ]. In our cohort, 71.3% (62/87) had a posterior wall left in situ and we do not anticipate that this alone contributed to post-operative morbidity.…”

“…Whilst the overall morbidity of laparoscopic subtotal is lower than open subtotal, it remains unclear the proportion of difficult cholecystectomies which would proceed to a total cholecystectomy if converted to open [ 9 ]. The paradigm shift in favour of SLC may be driven by familiarity with laparoscopic salvage options and inexperience with open cholecystectomy, instead of favourable outcomes [ 22 , 32 ].…”

Ectopic Liver Tissue Encountered Incidentally During a Laparoscopic Cholecystectomy: A Case Report

“…Laparoscopic cholecystectomy is the most commonly performed surgical procedure [4] and is also the most likely to have incidental findings [1]. The incidence of incidental findings in abdominal surgery is estimated to be 1.1% [1].…”

“…With a prevalence rate of approximately 0.28% in laparoscopic procedures, these anomalies are usually asymptomatic and often go unnoticed until they present as soft-tissue masses during routine medical procedures [2]. This report presents a unique case of an ectopic liver mass discovered during laparoscopic cholecystectomy, one of the most frequently performed surgical procedures worldwide [4]. Because it is a rare and complex discovery, it is important to understand not only the immediate surgical implications but also the potential long-term effects on patient health and quality of life [5].…”