Laparoscopic Cholecystectomy: Training, Learning Curve, and Definition of Expert

Abstract

Since the first laparoscopic cholecystectomy was performed, literature validated the procedure as gold standard. Nevertheless, it continues an important discussion about methods to perform the procedure and about the best way to teach the procedure to surgical trainee. A literature search has been done in PubMed starting from 1994/01/01 to 2012/12/31 with the following limits and filters: human, adult, clinical trial, review, and English language. The PICO (population, intervention, comparison, outcome) system was applied for the MeSH (Medical Subject Headings) search whenever possible. Analogous search has covered the Cochrane Collaboration database in order to gather all the remaining evidence, synopses, and guidelines on the topic. We can conclude that:

• (a) The most important element in training a specific surgical procedure remains the hands-on training on a real patient with an experienced surgeon at the trainee’s side. Virtual reality training can supplement standard laparoscopic surgical training of apprenticeship and is as effective as video trainer training in supplementing standard laparoscopic training.

• (b) It’s recommended that the learning curve be performed initially in only carefully selected patients under the supervision of an experienced surgeon. Virtual or standard laparoscopic training can significantly increase the skills and reduce the learning curve in LC.

• (c) The number of procedures required to reach proficiency in laparoscopic surgery has not been defined clearly. The expert as defined by the skills and experience cannot be numerically validated. The expert is to be the right harmony between experience, technical skills, and predispositions of the individual surgeon. However, the definition of “expert” cannot be separated from the concept of hospital volume and surgeon volume.