Learning curve for performing laparoscopic common bile duct exploration in biliary surgery 2.0 era

• Published in: Journal of hepato-biliary-pancreatic sciences 2023-03, Vol.30 (3), p.374-382
• Main Authors: Durán, Manuel, Silvestre, José, Hernández, Jara, Briceño, Javier, Martínez‐Isla, Alberto, Martínez‐Cecilia, David
• Format: Article
• Language: English
• Subjects: Bile ducts; cholangioscopy; Cholecystectomy, Laparoscopic - adverse effects; Cholecystectomy, Laparoscopic - methods; choledocholithiasis; Choledocholithiasis - etiology; common bile duct; Common Bile Duct - surgery; Humans; laparoscopic cholecystectomy; laparoscopic common bile duct exploration; Laparoscopy; Learning Curve; Length of Stay; Postoperative Complications - surgery; Retrospective Studies
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.1228

Background Recent trials and metanalysis have demonstrated the favorable results of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) for the treatment of cholecysto‐choledocholithiasis. The aim of this study was to evaluate the LC + LCBDE learning curve including transcystic and transductal approaches and its effect on the outcomes. Methods We identified all unselected patients who underwent LC + LCBDE by a single surgeon between May 2017 and July 2021. Pre‐, intra‐, and postoperative data were analyzed using the cumulative sum (CUSUM) analysis to evaluate the learning curve. Results A total of 110 patients were included. Total postoperative complications rate was 12.7%, including bile leakage in six (5.5%) patients. Mean length of hospital stay was 2.7 (1‐14) days. No patient had conversion to open surgery. The CUSUM graph divided the learning curve into three distinct phases: (1) Learning (1–38), (2) Competence (39–61) and (3) Proficiency (62–110). There was a significant increase in the transcystic approach rate with each phase (44.7% vs 73.9% vs 98%; P