Self-reported open cholecystectomy training, practice, and confidence in the laparoscopic era: An international convenience-sample survey

Table 1 Self-reported cumulative cholecystectomy volume by approach and role (n = 391)

Cholecystectomies performed	0-10	11-30	31-50	51-100	> 100
Laparoscopic (primary surgeon)	36 (9.2)	34 (8.7)	25 (6.4)	29 (7.4)	267 (68.3)
Robotic (primary surgeon)	369 (94.4)	10 (2.6)	4 (1.0)	4 (1.0)	4 (1.0)
Open (primary surgeon)	116 (29.7)	51 (13.0)	36 (9.2)	41 (10.5)	147 (37.6)
Open (as assistant)	97 (24.8)	64 (16.4)	47 (12.0)	39 (10.0)	144 (36.8)

Values are n (%). All rows sum to 391 respondents; there were no missing responses for these items.

Table 2 Training, supervision, formal assessment and training-format exposure (n = 391)

Item	n/N	%
Open cases during residency reported as sufficient for independent performance	248/391	63.4
Directly observed and informally evaluated by a supervisor	325/391	83.1
Formal standardized skills assessment (OSATS or GOALS)	81/391	20.7
Simulation or hands-on training focused on emergency conversion	64/391	16.4
Has ever converted a laparoscopic cholecystectomy to open	322/391	82.4
Formal training in common bile duct exploration	238/391	60.9
Formally evaluated in open surgical skills as part of the curriculum	226/391	57.8
Training formats ever used (multiple response)
Operating-room mentorship by a senior surgeon	307/391	78.5
Video-based training	98/391	25.1
Live animal laboratory	53/391	13.6
Cadaver laboratory	37/391	9.5
Dry laboratory	23/391	5.9
Modality of CBDE training, among the 238 reporting formal training
Open only	81/238	34.0
Laparoscopic only	28/238	11.8
Both open and laparoscopic	129/238	54.2
Modality item as answered by the 153 reporting no formal training
Open only	49/153	32.0
Laparoscopic only	36/153	23.5
Both open and laparoscopic	68/153	44.4

The modality item was written as conditional on reporting formal common bile duct exploration training but was presented without automated branching and was answered by all 391 respondents; both subgroups are shown so that the denominators are explicit. CBDE: Common bile duct exploration; GOALS: Global Operative Assessment of Laparoscopic Skills; OSATS: Objective Structured Assessment of Technical Skills.

Table 3 Self-reported confidence in key intraoperative steps of open cholecystectomy and perceived usefulness of training formats (n = 391)

Item	1 (lowest)	2	3	4	5 (highest)
Dissection and control of the cystic artery and duct	30 (7.7)	21 (5.4)	40 (10.2)	83 (21.2)	217 (55.5)
Obtaining the critical view of safety	26 (6.6)	24 (6.1)	50 (12.8)	81 (20.7)	210 (53.7)
Surgical exploration of the common bile duct	69 (17.6)	45 (11.5)	78 (19.9)	88 (22.5)	111 (28.4)
Intraoperative identification and repair of bile duct injury	62 (15.9)	65 (16.6)	89 (22.8)	87 (22.3)	88 (22.5)
Perceived usefulness of training formats received	24 (6.1)	26 (6.6)	66 (16.9)	101 (25.8)	174 (44.5)

Values are n (%). Ordinal categories were not treated as interval data; no means or composite scores were computed. Anchors as presented to respondents: 1 = not at all confident and 5 = very confident for the cystic pedicle, critical view of safety and bile duct injury items; 1 = not at all confident and 5 = extremely confident for common bile duct exploration; 1 = not useful and 5 = extremely useful for the perceived usefulness of training formats.

Table 4 Cumulative open cholecystectomy volume as primary surgeon, stratified by years of practice and by current role (n = 391)

Stratum	0-10	11-30	31-50	51-100	> 100
By years of practice
1-5 years (n = 60)	26 (43.3)	11 (18.3)	8 (13.3)	6 (10.0)	9 (15.0)
5-10 years (n = 46)	9 (19.6)	9 (19.6)	8 (17.4)	12 (26.1)	8 (17.4)
10-15 years (n = 43)	5 (11.6)	9 (20.9)	4 (9.3)	6 (14.0)	19 (44.2)
15-20 years (n = 32)	1 (3.1)	3 (9.4)	4 (12.5)	4 (12.5)	20 (62.5)
More than 20 years (n = 104)	3 (2.9)	2 (1.9)	3 (2.9)	11 (10.6)	85 (81.7)
Not answered (n = 106)	72 (67.9)	17 (16.0)	9 (8.5)	2 (1.9)	6 (5.7)
By current role
Residents (n = 105)	71 (67.6)	17 (16.2)	7 (6.7)	3 (2.9)	7 (6.7)
Fellows (n = 16)	3 (18.8)	3 (18.8)	2 (12.5)	1 (6.3)	7 (43.8)
Attendings (n = 270)	42 (15.6)	31 (11.5)	27 (10.0)	37 (13.7)	133 (49.3)

Values are n (%) within each stratum. No statistical comparison was performed. The not-answered stratum corresponds to respondents who did not answer the item on years of practice, of whom 92 were residents, 9 fellows and 5 attendings. Strata are approximate because the years-of-practice options overlap at their limits.

Table 5 Respondent characteristics (n = 391)

Characteristic	n	%
Current role
General surgery resident	105	26.9
Fellow - hepatopancreatobiliary surgery	5	1.3
Fellow - minimally invasive surgery	7	1.8
Fellow - trauma, critical and acute care surgery	4	1.0
Attending general surgeon	137	35.0
Attending hepatopancreatobiliary surgeon	30	7.7
Attending minimally invasive surgeon	48	12.3
Attending trauma and acute care surgeon	55	14.1
Postgraduate year (residents, n = 105)
PGY-1	14	13.3
PGY-2	32	30.5
PGY-3	46	43.8
PGY-4	1	1.0
PGY-5	12	11.4
Years of practice after completion of training
1-5 years	60	15.3
5-10 years	46	11.8
10-15 years	43	11.0
15-20 years	32	8.2
More than 20 years	104	26.6
Not answered	106	27.1

Percentages for current role and years of practice are calculated over the full sample (n = 391); percentages for postgraduate year are calculated over the 105 residents. The response options for years of practice are reproduced exactly as presented to respondents and overlap at 5, 10, 15 and 20 years, which is a limitation of the instrument. The item was directed at attending surgeons but, having been presented without automated branching, was answered by 285 respondents (265 attendings, 7 fellows, 13 residents); the 106 non-responders comprised 92 residents, 9 fellows and 5 attendings. Because the options overlap and the item was not restricted to attendings, these strata are approximate. PGY: Postgraduate year.