Published online Nov 27, 2026. doi: 10.4240/wjgs.126888
Revised: September 3, 2026
Accepted: October 21, 2026
Published online: November 27, 2026
Processing time: 89 Days and 6.5 Hours
Open cholecystectomy has become an infrequently performed rescue operation that is required precisely when laparoscopic dissection is unsafe, when the critical view of safety cannot be obtained, or when bile duct injury is suspected. The training that supports this operation in the laparoscopic era is poorly characterized at the surgeon level, and it is not known how often standardized asse
To describe self-reported operative exposure, structured training, intraoperative practice and confidence regarding open cholecystectomy among surgeons res
Anonymous cross-sectional online survey using an investigator-designed 24-item questionnaire disseminated by nonprobability convenience sampling through professional messaging groups of general, trauma and emergency, and hepatopancreatobiliary surgeons and through the channels of a national surgical society between July 2025 and February 2026; no sampling frame was defined and no response rate could be calculated. Eligible respondents were general surgery residents, fellows and attending surgeons. Analyses were descriptive and item-level; primary estimates are reported with Wilson 95% confidence intervals (CI), and no inferential comparisons were performed. Cumulative open cholecystectomy volume is additionally presented stratified by years of practice and by current role. The internal structure of the instrument was examined in a separate psychometric evaluation reported as Supplementary material. Confidence items were recorded on 5-point ordinal scales with explicit verbal anchors and are reported as complete response distributions. The instrument did not include an item on country or region of practice.
All 391 submitted questionnaires were complete and non-duplicate and were analyzed (270 attendings, 105 residents, 16 fellows); 68.3% (95%CI: 63.5-72.7) reported more than 100 laparoscopic cholecystectomies as primary surgeon, compared with 37.6% (95%CI: 32.9-42.5) for open cholecystectomy; 29.7% (95%CI: 25.4-34.4) reported 10 or fewer open cases. Direct observation by a supervisor was reported by 83.1% (95%CI: 79.1-86.5), but formal standardized assessment with the Objective Structured Assessment of Technical Skills or the Global Operative Assessment of Laparoscopic Skills was reported by only 20.7% (95%CI: 17.0-25.0), and simulation or hands-on training addressing emergency conversion by 16.4% (95%CI: 13.0-20.4). Intraoperative cholangiography was used selectively by 69.8% and indocyanine green fluorescence was never used by 77.5%. Self-reported confidence was concentrated in the highest category for the cystic pedicle (55.5%) and the critical view of safety (53.7%), but dispersed across all categories for common bile duct exploration and for identification and repair of bile duct injury, for which 32.5% (95%CI: 28.0-37.3) selected the two lowest categories. The instrument did not support a unidimensional measurement model, so all results are reported item by item.
Among these self-selected respondents, open cholecystectomy exposure, standardized assessment and conversion-specific simulation were heterogeneous and frequently limited, and self-reported confidence fell sharply for the biliary scenarios in which open expertise is most consequential. These findings concern self-reported confidence rather than objective competence and do not describe a defined surgical workforce.
Core Tip: Among 391 self-selected respondents to an internationally disseminated survey, laparoscopic and open cholecystectomy exposure diverged sharply: Two thirds reported more than 100 laparoscopic cases as primary surgeon, but only about one third reported the same for the open operation and nearly one in three reported ten or fewer. Only one in five had ever undergone standardized skills assessment and one in six had received simulation training for emergency conversion. Self-reported confidence remained high for routine steps but fell for common bile duct exploration and for repair of bile duct injury, the scenarios in which open biliary competence actually matters. Because the sample was self-selected and confidence is not competence, these findings are descriptive and hypothesis-generating.