Abstract
Faced with the task of introducing laparoscopic techniques for cholecystectomy into the practice of a large department composed of individuals with varied backgrounds and experience, our surgical staff decided to grant provisional privileges to five surgeons, two from the full-time faculty and three from the community, who had completed a formal course in laparoscopic cholecystectomy. These five surgeons agreed to assist one another through 10 cases apiece before performing any procedures on their own or serving as preceptors for additional surgeons. Other surgeons could obtain credentials for this procedure by satisfying the same course criteria and receiving assistance from one of the five original surgeons during their first 10 cases. In the 14 months after September 1990, 250 laparoscopic cholecystectomies were performed by 19 different attending surgeons at our hospital. One death from hemorrhage (0.4%) and two bile duct injuries (0.8%) occurred in these patients. One of the bile duct injuries occurred after conversion to open cholecystectomy, as did the hemorrhage, which was from a vessel within the parenchyma of the gallbladder bed which rebled even after temporary control through open ligature technique. The second bile duct injury, the result of injudicious application of hemoclips for hemostasis, was minor in degree and the only injury to occur in a procedure conducted exclusively through the laparoscope. This experience demonstrates that laparoscopic techniques can be safely introduced into an environment involving multiple surgeons by adherence to a careful protocol of preceptored assistance.
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Berci G, Sackier JM, Paz-Partlow M (1991) Routine or selected cholangiography during laparoscopic cholecystectomy? Am J Surg 161: 355–360
Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, Trede M, Troidl H (1991) The European experience with laparoscopic cholecystectomy. Am J Surt 161: 385–387
Dashow L, Friedman I, Kempner R, Rudick J, McSherry C (1992) Initial experience with laparoscopic cholecystectomy at the Beth Israel Medical Center. Surg Gynecol Obstet 1975: 25–29
Davidoff AM, Pappas TN, Murray EA, Hilleren DJ, Johnson RD, Baker ME, Newman GE, Cotton PB, Meyers WC (1992) Mechanisms of major biliary injury during laparoscopic cholecystectomy. Ann Surg 215: 196–202
Dubois F, Icard P, Berthelot G, Levard H (1990) Coelioscopic cholecystectomy: preliminary report of 36 cases. Ann Surg 211: 60–62
Ferguson CM, Rattner DW, Warshaw AL (1992) Bile duct injury in laparoscopic cholecystectomy. Surg. Laparosc Endosc 2: 1–7
Flowers JL, Bailey RW, Scovill WA, Zucker KA (1991) The Baltimore experience with laparoscopic management of acute cholecystitis. Am J Surg 161: 388–392
Gilliland TM, Traverso LW (1990) Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long term relief of symptoms. Surg Gynecol Obstet 170: 39–44
Goodman GR, Hunter JG (1991) Results of laparoscopic cholecystectomy in a university hospital. Am J Surg 162: 576–579
Moossa AR, Easter DW, Van Sonnenberg E, Casola G, D'Agostino H (1992) Laparoscopic injuries to the bile duct: a cause for concern. Ann Surg 215: 203–208
Olson DO (1991) Laparoscopic cholecystectomy. Am J Surg 161: 339–344
Ponsky JL (1991) Complications of laparoscopic cholecystectomy. Am J Surg 161: 393–395
Reddick EJ, Olsen DO (1990) Outpatient laparoscopic laser cholecystectomy. Am J Surg 160: 485–489
Reddick EJ, Olsen D, Spaw A, Baird D, Asbun H, O'Reilly M, Fisher K, Saye W (1991) Safe performance of difficult laparoscopic cholecystectomies. Am J Surg 161: 377–381
Southern Surgeons Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324: 1073–1078
Way LW (1992) Bile duct injury during laparoscopic cholecystectomy. Ann Surg 215: 195
Zucker KA, Bailey RW, Gadacz TR, Imbembo AL (1991) Laparoscopic guided cholecystectomy. Am J Surg 161: 36–44
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Fiallo, V.M., O'Connor, F.X. & Reed, W.P. Preceptored introduction of laparoscopic techniques for cholecystectomy into a large university-affiliated medical center. Surg Endosc 8, 1063–1066 (1994). https://doi.org/10.1007/BF00705720
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DOI: https://doi.org/10.1007/BF00705720