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Addressing the gap in laparoscopic common bile duct exploration training for rural surgeons: imparting procedural ability is not enough

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Abstract

Background

Laparoscopic common bile duct exploration (LCBDE) is an underutilized therapy for choledocholithiasis. The driving factors of this practice gap are poorly defined. We sought to evaluate the attitudes and practice patterns of surgeons who underwent training courses using an LCBDE simulator.

Methods

Surgeons completed a half-day simulator-based LCBDE curriculum at national courses, including the American College of Surgeons Advanced Skills Training for Rural Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons annual meeting. Attitudes were assessed with Likert surveys immediately before and after curriculum completion. Follow-up surveys were distributed electronically.

Results

159 surgeons completed training during six courses. Surgeon attitudes regarding the overall superiority of LCBDE vs. ERCP shifted towards favoring LCBDE after course participation (4.0 vs 3.3; Likert scale 1–5, p < 0.001). 44% of surgeons completed follow-up surveys at a mean of 3 years post-course. Surgeons remained confident in their ability to perform LCBDE, with only 14% rating their skill as a significant barrier to practice, as compared with 43% prior to course participation (p < 0.01). However, only 28% of surgeons saw an increase in LCBDE volume. Deficiencies in operating room (OR) staff knowledge and instrument availability were the most significant barriers to post-course practice implementation and were inversely correlated with LCBDE case volume (ρ = − 0.44 and − 0.47, both p < 0.01). Surgeons for whom OR staff knowledge of LCBDE was not a significant barrier performed nearly 4 times more LCBDE than those who rated staff knowledge as a moderate, strong, or complete barrier.

Conclusions

Surgeons trained at an LCBDE course retained long-term confidence in their procedural ability. Practice implementation was hindered by deficiencies in OR staff knowledge and instrument availability. Surgeons with knowledgeable operating room staff performed significantly more LCBDEs than those with less capable assistance. These barriers should be addressed in future curricula to improve procedural adoption.

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Funding

Ryan A. J. Campagna, MD is supported by T32DK101363 from the National Institutes of Health.

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Authors and Affiliations

  1. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Ryan A. J. Campagna, Allison M. Belette, Amy L. Holmstrom, Amy L. Halverson, Eric S. Hungness & Ezra N. Teitelbaum

  2. Department of Surgery, Dartmouth Geisel School of Medicine, Lebanon, NH, USA

    Byron F. Santos

  3. Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 2320, Chicago, IL, 60611, USA

    Ryan A. J. Campagna

Authors
  1. Ryan A. J. Campagna
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  2. Allison M. Belette
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  3. Amy L. Holmstrom
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  4. Amy L. Halverson
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  5. Byron F. Santos
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  6. Eric S. Hungness
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  7. Ezra N. Teitelbaum
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Corresponding author

Correspondence to Ryan A. J. Campagna.

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Disclosures

Dr. Santos: Cook Medical—consulting; Boston Scientific—consulting. Dr. Hungness: Cook Medical—consulting; Boston Scientific—consulting. Dr. Teitelbaum: Cook Medical—consulting; Boston Scientific—consulting. Dr. Campagna reports grants from the National Institutes of Health during the conduct of the study. Ms. Belette, Dr. Holmstrom, and Dr. Halverson have nothing to disclose.

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Campagna, R.A.J., Belette, A.M., Holmstrom, A.L. et al. Addressing the gap in laparoscopic common bile duct exploration training for rural surgeons: imparting procedural ability is not enough. Surg Endosc 35, 5140–5146 (2021). https://doi.org/10.1007/s00464-020-08003-7

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  • DOI: https://doi.org/10.1007/s00464-020-08003-7

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