Learning curve in laparoscopic cholecystectomy: a prospective observational study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20262617Keywords:
Surgical training, Operative time, Learning curve, Laparoscopic cholecystectomy, Conversion rate, Hospital stayAbstract
Background: Laparoscopic cholecystectomy is the gold standard treatment for cholelithiasis. However, mastering laparoscopic skills requires structured training and experience. Evaluation of operative time, intraoperative complications, conversion rate, and hospital stay helps define the learning curve in laparoscopic.
Methods: A prospective observational study was conducted on 36 consecutive elective laparoscopic cholecystectomy cases. Parameters assessed included operative time, intraoperative complications, conversion to open surgery, need for senior assistance, and duration of hospital stay. Sequential case analysis was performed to assess improvement in surgical performance over time.
Results: The overall mean operative time was progressive reduction in later cases. Conversion to open surgery occurred in 8.33% of cases, predominantly in early cases. Intraoperative complications were more frequent during the initial cases and declined with increasing experience. The requirement for senior assistance decreased progressively. The mean hospital stay was 2-3 days, with shorter stays observed in later cases.
Conclusions: A definite learning curve exists in laparoscopic cholecystectomy, with significant improvement in operative time, reduction in complications, and decreased conversion rates. Supervised training and gradual exposure to increasing case complexity are essential for safe skill acquisition.
References
Lammert F, Gurusamy K, Ko CW, Miquel JF, Nahum Méndez-Sánchez N, Portincasa P, et al. Gallstones. Nat Rev Dis Primers. 2016;2:16024.
Stinton LM, Shaffer EA. Epidemiology of gallbladder disease. Best Pract Res Clin Gastroenterol. 2012;26(5):453-67.
National Institute for Health and Care Excellence. Gallstone disease: diagnosis and management (NG188). 2018. Available from: https://www.nice.org.uk/guidance/cg188. Accessed on 2 March 2026.
Portincasa P, Di Ciaula A, Wang DQH. Pathogenesis of gallstones. Best Pract Res Clin Gastroenterol. 2006;20(6):981-96.
European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on gallstones. J Hepatol. 2016;65(1):146-81.
Maple JT, Ben-Menachem T, Anderson MA, Appalaneni V, Banerjee S, Cash BD, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastroint Endosc. 2010;71(1):1-9.
Kehlet H. Fast-track surgery- an update on physiological care principles. Clin Nutr. 2011;30(2):145-8.
Strasberg SM. Clinical practice: acute calculous cholecystitis. N Engl J Med. 2008;358:2804-11.
Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi S, Boerna D, et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020;15(1):61.
Elwood DR. Cholecystitis. Surg Clin North Am. 2008;88(6):1241-52.
Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Elsevier; 2022.
Reynolds W Jr. The first laparoscopic cholecystectomy. JSLS. 2001;5(1):89-94.
Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ. Laparoscopic versus open cholecystectomy. Cochrane Database Syst Rev. 2006;(4):CD006231.
Bailey H, Love RM. Bailey and Love’s Short Practice of Surgery. 28th ed. CRC Press; 2022.
Elshaer M, Gravante G, Thomas K, Sorge R, Al-Hamali S, Ebdewi H. Subtotal cholecystectomy for “difficult gallbladders” systematic review and meta-analysis. JAMA Surg. 2015;150(2):159-68.
Livingston EH, Rege RV. Conversion to open cholecystectomy. Ann Surg. 2004;239(1):74-81.
Teodor P. Grantcharov, Reznick RK. Teaching procedural skills. BMJ. 2008;336(7653):1129-31.
Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparoscopic cholecystectomy learning curve. Ann Surg. 1992;216(5):655-62.
Deziel DJ, Millikan KW, Economou SG. Complications of laparoscopic cholecystectomy. Am J Surg. 1993;165(1).
Moore MJ, Bennett CL. Learning curve for laparoscopic cholecystectomy. Am J Surg. 1995;170(1):55-9.
Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes and learning curve analysis. Ann Surg. 2000;232(5):689–696.
Richardson MC, Bell G, Fullarton GM. Incidence and nature of bile duct injury. Br J Surg. 1996;83(10):1356-60.
Aggarwal R, Darzi A. Technical-skills training in surgery. BMJ. 2006;332(7536):341-5.
Southern Surgeons Club. A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med. 1991;324(16):1073-8.
Hugh TB. New strategies to prevent bile duct injury. Ann Surg. 2002;235(1):1-2.
Downloads
Published
How to Cite
Issue
Section
