Badellino, Michael M, MD

Dangleben, Dale A, MD

Hong, John J, MD

Lawless, Ryan A, MD

Olenwine, Judith A, MS, C-TAGME

Scagliotti, Charles, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of SurgeryExperience of Resident Assistant Does NotInfluence Incidence of Common Bile Duct InjuriesDuring Laparoscopic CholecystectomyRyan A. Lawless MDLehigh Valley Health Network, Ryan_A.Lawless@lvhn.orgDale A. Dangleben MDLehigh Valley Health Network, Dale_A.Dangleben@lvhn.orgCharles Scagliotti MDLehigh Valley Health Network, Charles.Scagliotti@lvhn.orgJudith A. Olenwine MS, C-TAGMELehigh Valley Health Network, Judith.Olenwine@lvhn.orgJohn J. Hong MDLehigh Valley Health Network, john_j.hong@lvhn.orgSee next page for additional authorsFollow this and additional works at: http://scholarlyworks.lvhn.org/surgeryPart of the Other Medical Specialties Commons, and the Surgery CommonsThis Presentation is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works byan authorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtLawlwess, R., Dangleben, D., Scagliotti, C., Olenwine, J., Hong, J., & Badellino, M. (2011, October 24). Experience of resident assistantdoes not influence incidence of common bile duct injuries during laparoscopic cholecystectomy. Presented at: The 97th Annual AmericanCollege of Surgeons Clinical congress, San Francisco, CA.AuthorsRyan A. Lawless MD; Dale A. Dangleben MD; Charles Scagliotti MD; Judith A. Olenwine MS, C-TAGME;John J. Hong MD; and Michael M. Badellino MDThis presentation is available at LVHN Scholarly Works: http://scholarlyworks.lvhn.org/surgery/12Experience of Resident Assistant Does Not Infl uence Incidence of Common Bile Duct Injuries During Laparoscopic CholecystectomyRyan A. Lawless, MD, Dale A. Dangleben, MD, Charles Scagliotti, MD, Judith A. Olenwine, MS, C-TAGME, John J. Hong, MD, Michael M. Badellino, MD, Lehigh Valley Health Network, Allentown, PennsylvaniaBackgroundCommon bile duct injuries (CBDI) are a signifi cant complication of the 800,000 cholecystectomies that are performed yearly in the United States. The CBDI rate for laparoscopic cholecystectomy (LC) is around 0.5%. A recent publication urged practicing general surgeons to perform cholecystectomy with a qualifi ed assistant, i.e., another surgeon as  opposed to a surgery resident, to  decrease the chance of CBDI and  litigation. The aim of this study was to determine if a correlation between resident level of education and CBDI exists.MethodsA retrospective review of laparoscopic cholecystectomies was performed at a single institution from 2003–2008. Data collected included demographics, postgraduate year (PGY) of the assisting  resident, incidence of CBDI, and other reported injuries. General surgery  attendings were also surveyed regarding practice patterns. ResultsOf the 3484 laparoscopic cholecystec-tomies performed, 5 (0.14%) CBDI  occurred. The assistants were PGY4 or 5 residents. Fifteen other injuries  occurred with a rate four times greater than that of CBDI at 0.43%. ConclusionCBDIs are among the most signifi cant complications in a general surgery practice. Our data, from a large residency program (four categorical residents/year during the study period), show a CBDI injury rate well below the nationally quoted rate. All PGY levels assist in LC and with the rate of CBDI at our institution being well below the accepted percentage. No correlation between CBDI and level of the PGY assistant was shown.Figure 2: Comparison of average number of laparoscopic  cholecystomies performed by residents at Lehigh Valley Health Network compared to national averages.Figure 1: Average number of laparoscopic cholecystomies performed per post-graduate year at Lehigh Valley Health Network.Years in PracticeAverage Number per YearPneumoperitoneum  TechniqueIndication for HassonVeress@ Palmer’s PointRoutine IOCIndication for IOCResident  Performing 50% of CasesTrigger to Take Over Dissection12 25 veress previous midline incision no4 100 veress previous  midline noanatomy/diffi cult dissectionjunior12 25 veress recent midline laparotomy no17 20 veress previous midline incision noanatomy/CBD stone senior diffi culty, ID sutures20 175 veressmultiple previous abdominal surgeriesyes n/a junior diffi cult anatomy/signifi cant bleeding20 75 both extensive surgery yes n/a interndiffi cult dissection, unclear anatomy, failure to progress10 50 veress previous surgery no3.5 50 veress prior LUQ surgery yes n/aNR 30 veress prior surgery/scar tissue noACS criteria/never for anatomyinternpossible injury, resident not able to perform dissectionTable 3: Survey results from nine  general surgery attendings at Lehigh Valley Health Network regarding  clinical practice and resident  education.Pt Age Diagnosis Access Location Previous Surgery PGY Conversion CBD Stones Injury Delay1 79 Cholecystitis Veress Umbilical None 4 Yes No No2 80 Cholecystitis Veress Umbilical Open appy 5 Yes No No3 68 Cholecystitis Veress Umbilical RYGPB 4 Yes No No4 59 Cholecystitis Veress Umbilical None 5 No No No5 61 Cholecystitis Veress Umbilical None 4 No No NoTable 1: Demographics of the fi ve patients who suffered a common bile duct injury during the study period.PtAttending (yrs in practice) Diffi culty IOC Injury Management Final Pathology1 10 Omental adhesions No proximal fi lling Cystic duct/CBD  junction 18 Fr T tube Acute cholecystitis2 17 Adhesions No Proximal fi lling CBD clipped and cut 12 Fr T tube Acute cholecystitis3 17 Perc chole, adhesions n/a Cystic duct avulsion 12 Fr T tube Severe acute infl ammation of GB4 9 Adhesions No proximal fi lling CBD clipped and cut 14 Fr T tube Gangrenous  cholecystitis5 18 Adhesions No proximal fi lling CBD clipped and cut 12 Fr T tube Acute cholecystitisTable 2: Characteristics of the injury and management of the fi ve common bile duct injuries during the study period.0102030405060 1 2 3 4 5PGY statusLaparoscopic cholecystectomy average by PGY status for year 2007–2008Number of cases020406080100120140Surgeon Junior Surgeon ChiefAverage Results for Laparoscopic CholecystectomyNumber of cases ■ LVHN■ National

Experience of Resident Assistant Does Not Influence Incidence of Common Bile Duct Injuries During Laparoscopic Cholecystectomy

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Experience of Resident Assistant Does Not Influence Incidence of Common Bile Duct Injuries During Laparoscopic Cholecystectomy

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