Standardizing laparoscopic procedure time and determining the effect of patient age/gender and presence or absence of surgical residents during operation

Abstract

Background: Most of the expense of laparoscopic cholecystectomy (LC) is incurred while the patient is in the operating room (OR). Half of this operating room cost is equipment and the other half is personnel. What is an acceptable LC procedure time and how much variation is there? What are the effects of age, gender, and expertise on the mean LC procedure time?

Methods: A prospective, multicenter gathering of LC procedure times and task component times was performed through the cooperative effort of members of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) at 11 hospitals. The effect of LC time of age, gender, and surgical resident was recorded.

Results: The mean LC time for 359 cases was 73 ± 28 min. The percent of this LC time for the following component tasks included: to place and remove trocars, 34%; total dissection time, 40%; intraoperative cholangiogram, 15%; and removing the gallbladder, 7%. Age and gender did not change LC time, but the presence of a surgical resident prolonged LC time from 53 to 79 min due to an increase in all LC component task times.

Conclusions: LC time was globally calibrated in 11 North American hospitals and was found to be affected by expertise but not by gender or age. The mean and standard deviation of LC time can be used for purposes of self-assessing quality performance.