Abstract
Background
Even though ambulatory laparoscopic cholecystectomy (ALC) is safe and cost effective, this approach has yet to gain acceptance in the United Kingdom. We report our 5-year experience of ALC with emphasis on its appropriateness for higher surgical training.
Methods
Between July 1997 and July 2002, patients with symptomatic cholelithiasis who met with appropriate criteria underwent ALC. Surgery was performed either by a consultant surgeon or a higher surgical trainee (HST) under direct supervision in our dedicated day surgery unit. Data were recorded prospectively and patients were interviewed postoperatively by an independent researcher.
Results
There were 269 patients (231 female and 38 male) with a median age of 46 years (range 17–76). Conversion to open cholecystectomy was necessary in three cases (1%). Of the patients, 79% (213) were discharged within 8 hours of surgery; 95% (256) were discharged on the same day. Thirteen patients (5%) required overnight admission as inpatients. An HST performed 166 (62%) of the procedures. There was a statistically significant difference in operating time between consultants (41 min) and trainees (47 min, P = 0.001) but no significant difference in clinical outcome or patient satisfaction. The mean procedural cost to the hospital was £768 for ALC compared with £1430 for an inpatient operation. Of patients, 87% expressed satisfaction with the day case operation.
Conclusion
Our results for ALC compare favorably with published series. In addition, we have demonstrated that the operation can be performed safely by HST under direct supervision without compromising operating lists or safety.
Similar content being viewed by others
References
DJ Alexander SS Ngoi L Lee (1996) ArticleTitleRandomised trial of periportal peritoneal bupivicaine for pain relief after laparoscopic cholecystectomy Br J Surg 83 1223–1225 Occurrence Handle10.1046/j.1365-2168.1996.02336.x Occurrence Handle8983611
JS Barkun AN Barkun JS Sampalis G Fried B Taylor MJ Wexler CA Goresky JL Meakin (1992) ArticleTitleRandomised controlled trial of laparoscopic versus mini cholecystectomy. The McGill Gallstone Treatment Group Lancet 340 1116–1119 Occurrence Handle10.1016/0140-6736(92)93148-G Occurrence Handle1359210
T Bates (1996) ArticleTitleCurricular training and the New Deal Ann R Coll Surg Eng (suppl) 78 61–62
B Cagir M Rangraj L Maffuci BL Herz (1994) ArticleTitleThe learning curve for laparoscopic cholecystectomy J Laparoendosc Surg 4 IssueID6 419–427 Occurrence Handle7881146
KC Calman JG Temple R Naysmith RG Cairncross SJ Bennett (1999) ArticleTitleReforming higher specialist training in the United Kingdom—a step along the continuum of medical education Med Educ 33 28–33 Occurrence Handle10.1046/j.1365-2923.1999.00356.x Occurrence Handle10211274
S Chesser K Bowman H Phillips (2002) ArticleTitleThe European Working Time Directive and the training of surgeons Br Med J 325 s69–70
Department of Health. Day surgery—operational guide. http://www.doh.gov.uk/daysurgery/ 2002; accessed 30 December 2004
Department of Health. European working time directive. http://www.doh.gov.uk/workingtime/index.html 2002; accessed 30 December 2004
LA Fleisher K Yee K Lillemoe MA Talamini CJ Yeo RN Heath E Bass DS Snyder S Parker (1999) ArticleTitleIs outpatient laparoscopic cholecystectomy safe and cost-effective? A model to study transition of care Anesthesiology 90 1746–1755 Occurrence Handle10.1097/00000542-199906000-00033 Occurrence Handle10360875
PA Grace A Quereshi J Coleman R Keane G McEntee P Broe H Osborne D Bouchier-Hayes (1991) ArticleTitleReduced postoperative hospitalisation after laparoscopic cholecystectomy Br J Surg78 160–162
A Hawasli LR Lloyd (1991) ArticleTitleLaparoscopic cholecystectomy: The Learning Curve: report of 50 patients Am Surg 57 IssueID8 542–544 Occurrence Handle1834000
A Huang C Stinchcombe D Phillips DL McWhinnie (2000) ArticleTitleProspective 5 year audit for day-case laparoscopic cholecystectomy Br J Surg 87 IssueID3 362–373 Occurrence Handle10.1046/j.1365-2168.2000.01383-12.x
H Lau DC Brookes (2001) ArticleTitlePredictive factors for unanticipated admissions after ambulatory laparoscopic cholecystectomy Arch Surg 136 IssueID10 1150–1153 Occurrence Handle10.1001/archsurg.136.10.1150 Occurrence Handle11585507
H Lau DC Brookes (2002) ArticleTitleTransitions in laparoscopic cholecystectomy: the impact of ambulatory surgery Surg Endosc 16 IssueID2 323–326 Occurrence Handle10.1007/s00464-001-8114-x Occurrence Handle11967689
KD Lillemoe JW Lin MA Talamini CJ Yeo DS Snyder SD Parker (1999) ArticleTitleLaparoscopic cholecystectomy as a “true” outpatient procedure: initial experience in 130 consecutive patients J Gastrointest Surg 3 44–49 Occurrence Handle10.1016/S1091-255X(99)80007-9 Occurrence Handle10457323
O Mjaland J Raeder V Aasboe E Trondsen T Buanes (1997) ArticleTitleOutpatient laparoscopic cholecystectomy Br J Surg 84 958–961 Occurrence Handle9240135
PK Narain EJ DeMaria (1997) ArticleTitleInitial results of a prospective trial of outpatient laparoscopic cholecystectomy Surg Endosc 11 1091–1094 Occurrence Handle10.1007/s004649900537 Occurrence Handle9348381
A Prasad RJ Foley (1996) ArticleTitleDay case laparoscopic cholecystectomy: a safe and cost effective procedure E J Surg 162 IssueID1 43–46
MJ Rosen JA Malm M Tarnoff K Zuccala JL Ponsky (2001) ArticleTitleCost effectiveness of ambulatory laparoscopic cholecystectomy Surg Laparosc Endosc 11 182–184 Occurrence Handle10.1097/00019509-200106000-00006
AS Serra MP Roig JB Lledo AS Santafe RG Espinosa CA Bertomeu M Guillemot PM Casan (2002) ArticleTitleThe learning curve in ambulatory laparoscopic cholecystectomy Surg Laparosc Endosc Percutan Tech 12 IssueID5 320–324 Occurrence Handle10.1097/00129689-200210000-00003 Occurrence Handle12409697
NJ Soper PT Stockmann DL Dunnegan S Ashley (1992) ArticleTitleLaparoscopic cholecystectomy: the new “gold standard”? Arch Surg 127 917–921 Occurrence Handle1386505
AJ Voitk SG Tsao S Ignatius (2001) ArticleTitleThe tail of the learning curve for laparoscopic cholecystectomy Am J Surg 182 IssueID3 250–253 Occurrence Handle10.1016/S0002-9610(01)00699-7 Occurrence Handle11587686
RF Zegarra AK Saba JL Peschiera (1997) ArticleTitleOutpatient laparoscopic cholecystectomy: safe and cost effective? Surg Laparosc Endosc 7 1487–1490
Acknowledgements
The authors thank Jackie Tomlinson and the staff of the day case surgery unit for assistance with prospective data collection and Anne Murray-Knagg for the procedural cost information.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jain, P.K., Hayden, J.D., Sedman, P. et al. A prospective study of ambulatory laparoscopic cholecystectomy: Training economic, and patient benefits. Surg Endosc 19, 1082–1085 (2005). https://doi.org/10.1007/s00464-004-2170-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-004-2170-y