Abstract
Background
Laparoscopic common bile duct exploration is safe and effective for managing choledocholithiasis,
but laparoscopic common bile duct exploration is rarely performed, which threatens
surgical trainee proficiency. This study tests the hypothesis that prior operative
or simulation experience with laparoscopic common bile duct exploration is associated
with greater resident operative performance and autonomy without adversely affecting
patient outcomes.
Methods
This longitudinal cohort study included 33 consecutive patients undergoing laparoscopic
common bile duct exploration in cases involving postgraduate years 3, 4, and 5 general
surgery residents at a single institution during the implementation of a laparoscopic
common bile duct exploration simulation curriculum. For each of the 33 cases, resident
performance and autonomy were rated by residents and attendings, the resident’s prior
operative and simulation experience were recorded, and patient outcomes were ascertained
from electronic health records for comparison among 3 cohorts: prior operative experience,
prior simulation experience, and no prior experience.
Results
Operative approach was similar among cohorts. Overall morbidity was 6.1% and similar
across cohorts. The operative performance scores were higher in prior experience cohorts
according to both residents (3.0 [2.8–3.0] vs 2.0 [2.0–3.0]; P = .01) and attendings (3.0 [3.0–4.0]; P < .001). The autonomy scores were higher in prior experience cohorts according to
both residents (2.0 [2.0–3.0] vs 2.0 [2.0–2.0]; P = .005) and attendings (2.5 [2.0–3.0] vs 2.0 [1.0–2.0]; P = .001). Prior simulation and prior operative experience had similar associations
with performance and autonomy.
Conclusion
Simulation experience with laparoscopic common bile duct exploration was associated
with greater resident operative performance and autonomy, with effects that mimic
prior operative experience. This illustrates the potential for simulation-based training
to improve resident operative performance and autonomy for laparoscopic common bile
duct exploration.
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Article info
Publication history
Published online: December 12, 2022
Accepted:
November 11,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
