The effect of residents as teaching assistants on operative time in laparoscopic cholecystectomy

Am J Surg. 2016 Jan;211(1):288-93. doi: 10.1016/j.amjsurg.2015.06.019. Epub 2015 Aug 12.

Abstract

Background: We examined the effect of primary surgeon (PS) and teaching assistant (TA) seniority on operative time and outcomes for residents performing laparoscopic cholecystectomy (LC).

Methods: This was a retrospective analysis of urgent LC at a county teaching hospital. Relevant data included postgraduate year (PGY) of the PS and TA and markers of disease severity. Primary outcome was operative time. Secondary outcomes were conversion to open cholecystectomy and complications.

Results: There were 1,202 LCs; 415 included an intraoperative cholangiogram. On multivariable analysis, every PGY increase of PS decreased operative time by 3.2 minutes (P = .02). For every PGY increase of TA, operative time decreased 10.8 minutes (P < .001). Acute or gangrenous pathology increased conversion to open surgery (P < .001). Seniority of PS and TA was not associated with increases in conversion or complication rates.

Conclusions: Residents' operative time improves as experience with LC increases. These improvements become more profound after adjusting for the seniority of the TA.

Keywords: Laparoscopic cholecystectomy; Operative time; Resident education; Teaching assistant.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • California
  • Cholecystectomy, Laparoscopic / education*
  • Cholecystectomy, Laparoscopic / statistics & numerical data
  • Clinical Competence
  • Conversion to Open Surgery / statistics & numerical data
  • Female
  • Hospitals, Teaching
  • Humans
  • Internship and Residency*
  • Learning Curve
  • Linear Models
  • Male
  • Multivariate Analysis
  • Operative Time*
  • Outcome and Process Assessment, Health Care
  • Postoperative Complications / epidemiology
  • Retrospective Studies