Background: Although laparoscopic cholecystectomy is the most commonly performed laparoscopic procedure in the United States, complications may still arise, especially when acute inflammation or aberrant anatomy is present. In these situations, surgeons may choose to convert to a variation of the traditional laparoscopic cholecystectomy, the "dome-down" approach. We assessed the best approach to teaching this technique as a secondary method in an academic teaching hospital.
Methods: Surgical residents were first given didactic instruction on the dome-down laparoscopic cholecystectomy, then trained in the animate laboratory, and finally graduated to the operating room. Following training, the residents completed a 7-question questionnaire to assess their reaction to this method. The charts of 98 patients who underwent dome-down laparoscopic cholecystectomy were retrospectively reviewed to assess the complications associated with the procedure, the average operative time, and length of hospital stay.
Results: The resident questionnaire showed that the learning curve was dramatically affected when an adequate number of cases were performed. The mean number needed to gain competency was 14.7. The use of animate simulators was also important. The mean operative time was 78.40 minutes, with most cases performed by postgraduate year-2 and -3 residents. Only one complication, bile peritonitis, arose early in the study.
Conclusion: Dome-down laparoscopic cholecystectomy must be taught to surgical residents as a secondary approach to use when faced with a difficult case. The most important factor in teaching this technique is exposure to an adequate number of cases. The use of animate simulators and didactic training is also helpful.