Background

The assessment of laparoscopic cholecystectomy (LC) skills using operating times has not been well reported. We examined the total and partial operating times for LC procedures performed by surgical trainees to determine the required number of surgeries until the surgical time stabilizes.

Methods

We reviewed the video records of 514 consecutive LCs using the three-port method, performed by 16 surgical trainees. The total and partial surgical times were calculated and correlated to the surgeons’ experience.

Results

The median total surgical time for a trainee’s first LC was 112 (range 71–226) minutes. It reduced rapidly after the first 20 LCs and plateaued to its minimum after approximately 60 cases. A statistically significant time decrease was observed between the first 10 (median, range 112, 46–252 min) and the next 50–59 cases (64, 34–198 min), but not between the 50–59 and the subsequent 100–109 cases (71, 33–127 min). The total times taken by trainees who had performed > 50 operations were not significantly different from those taken by instructors during the study period. Surgery for 125 patients with acute cholecystitis took a significantly longer time (median 99 vs. 74 min with non-acute cholecystitis); however, the abovementioned time reduction findings showed similar results regardless of the patient’s acute inflammation status. The partial operating times around the cervical/cystic duct and gallbladder bed reduced uniformly between the first 10 and the following 50–59 cases. Although time variations in total and cervical/cystic duct operating times were not correlated to the surgical experience, time fluctuation of gallbladder bed procedures reduced after 60 cases.

Conclusion

The time required to perform an LC was inversely correlated with the experience of surgical trainees and halved after the first 60 cases. The surgical experience required for LC time stabilization is approximately 60 cases.

中文翻译：

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外科实习生采用三端口法进行腹腔镜胆囊切除术手术时间的学习曲线：稳定需要多少例？

背景

使用手术时间评估腹腔镜胆囊切除术 (LC) 技能的报道尚未得到充分报道。我们检查了外科实习生执行的 LC 手术的总手术时间和部分手术时间，以确定在手术时间稳定之前所需的手术次数。

方法

我们使用三端口方法审查了 514 个连续 LC 的视频记录，这些记录由 16 名外科实习生执行。计算总手术时间和部分手术时间，并将其与外科医生的经验相关联。

结果

受训者第一次 LC 的中位总手术时间为 112（范围 71-226）分钟。它在前 20 个 LC 后迅速减少，并在大约 60 个案例后稳定到最低值。在前 10 个（中位数，范围 112、46-252 分钟）和接下来的 50-59 个案例（64、34-198 分钟）之间观察到具有统计学意义的时间减少，但在 50-59 和随后的 100- 109 例（71、33–127 分钟）。在研究期间，执行过 50 次以上手术的受训者所花费的总时间与教员所花费的总时间没有显着差异。125 名急性胆囊炎患者的手术时间明显更长（中位时间为 99 分钟，非急性胆囊炎患者为 74 分钟）；然而，无论患者的急性炎症状态如何，上述时间缩短的结果都显示出相似的结果。宫颈/胆囊管和胆囊床周围的部分手术时间在前 10 例和随后的 50-59 例之间均匀减少。虽然总手术时间和颈/胆囊管手术时间的时间变化与手术经验无关，但胆囊床手术的时间波动在 60 例后减少。

结论

执行 LC 所需的时间与外科实习生的经验呈负相关，并在前 60 例病例后减半。LC时间稳定所需的手术经验约为60例。