Laparoscopic cholecystectomy. The learning curve: report of 50 patients.

Laparoscopic cholecystectomy was first performed at Saint John Hospital in November 1989. This is a study of the first 50 patients operated on between November 1989 and March 1990. This new technique, which requires different eye-hand coordination and deals with new instruments, prompted an analysis of the first 25 patients (Group 1) vs the second 25 patients (Group 2) for complications, hospital stay, and operating time. All patients were candidates for elective cholecystectomy. There were 32 women and 18 men with an average age of 51 years (range of 20-72 years). There was an average weight of 174 lb (range of 107-265 lb). Group 1 had three minor complications: bile drainage (1), nausea (1), and pain (1). Group 2 only had one minor complication: nausea. Group 1 had four major complications: bile leak from the cystic duct (1), conversion to open cholecystectomy for bleeding (1), reoperation for control of liver oozing in an unsuspected cirrhotic (1), and common duct injury (1). Group 2 had no major complications. The hospital stay was 2.33 days (range of 1-13 days) and 1.04 days (range of 1-3 days) and the operating time was 134 minutes (range of 75-200 min) and 78 minutes (range of 50-150 min) for Group 1 and Group 2, respectively. Sixteen Group 1 patients (64%) and 24 Group 2 patients (96%) were outpatients. Significantly fewer complications, shorter hospital stay, and decreased operating time in Group 2 emphasize the importance of the learning experience.