Home E-Weekly April 12, 2016

More Lap Choles Means Less Open Experience

Published: April 11, 2016

While minimally invasive surgery has improved efficiency and patient outcomes, there could be a potential downside, according to researchers: fewer surgical residents have the skills needed to perform open surgeries.

In a new study, researchers from the University of Texas Health Science Center in San Antonio looked the hospital's cholecystectomy trends over the past 30 years and found that open procedures dropped by 90% during that time. They broke down the data into 3 different groups: cholecystectomies occurring between 1981 and 1990, which they called the pre-laparoscopic era; those between 1991 and 2001, the first decade of laparoscopic cholecystectomy; and those between 2004 and 2013, the most recent decade of laparoscopic cholecystectomy.

They found that compared with the pre-laparoscopic decade, the number of patients undergoing an open cholecystectomy decreased 67% during the first decade of laparoscopic cholecystectomy and 92% in the most recent decade. The researchers say that while laparoscopic procedures are the current standard, they worry that residents' lack of clinical experience could leave them unprepared in cases requiring them to convert a laparoscopic procedure to an open one.

"The average general surgery resident completing training in 2000 had performed 15.5 open cholecystectomies, versus 90 in the pre-laparoscopic era. This figure decreased to 12.6 by 2004," says lead study author Kenneth R. Sirinek, MD, PhD, FACS, professor and vice chairman of surgery at the University of Texas Health Science Center. "I fear that the next decade is going to be even worse."

Kendal Gapinski

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