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

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.