Trends in resident experience in open and laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) has replaced open cholecystectomy (OC) as the most common operation for gallbladder disease. Our goal was to determine the effect of this phenomenon on resident training in biliary surgery. The numbers of all cholecystectomies (ACs), OCs, LCs, and advanced procedures (common bile duct exploration and choledochoscopy, (CBDE) performed by residents during academic years 1989 to 1994 were examined. Trends for the residency as a whole and for each cohort of residents completing the program were studied. The number of LCs performed by the residency as a whole per academic year over the 1989 to 1994 period has increased, whereas the number of OCs decreased. The net effect of these trends was an increase in the number of ACs. Although the percentage of LCs performed by postgraduate year 1, 2, and 3 residents (juniors) increased over the study period, the proportion of OCs and ACs performed by this group decreased. For each cohort of residents completing training in the years 1989 through 1994, the number of ACs and LCs performed increased, whereas the number of OCs decreased. Experience in CBDE for the residency as a whole and for the cohort was stable. In conclusion, experience in ACs and LCs has increased, and experience in OCs has decreased. Also, experience in biliary surgery has shifted to the senior level.