Purposes : Technical skills of laparoscopic surgery is somewhat different from open surgery, so operators have to learn different skills. But there was no standardized format for evaluating laparoscopic skills. Thomas R Eubanks proposed an objective scoring system for laparoscopic cholecystectomy(LC). We applied this scoring system to our cases for assessing technical skills and evaluating the learning curve.
Methods : We reviewed videotapes and clinical records of 28 patients who had LC from July 1st 2000 to Dec. 31th 2000.
Results : The mean operative time (MOT) was 66.9 minutes (min.). The mean raw score was 79.1, the mean error point was 11.6 and the mean final score (MFS) was 67.5. 5 procedures (17.9%) did not successfully complete all the steps. The most frequent errors were liver injury with no bleeding (87.5%), unintentional release of gallbladder (53.6%), additional attempt at cystic duct (46.4%), spilled bile or gall stone (25.0%), slipped trocar (21.4%) in order of frequency. There was no major injury except 1 case of cystic artery tear. The longer operations above the MOT were 11 cases and its MFS was 62.9 and shorter operations were 17 cases and its MFS was 70.8. The higher cases the MFS were 18 and its MOT was 60.1 min. and the lower group were 10 cases and its MOT was 77.2 min. But there was no statistical significance between operative time and final score. 9 cases were acute cholecystitis, its MOT was 84.2 min. and its MFS was 57.7, other 19 cases showed that its MOT was 57.7 min. and its MFS was 71.8. But there was no statistical significance of operative time and final score between acute cholecystitis and others.
Conclusion : The scoring system proposed by Eubanks seems to be a reliable tool for evaluating the technical skills and learning curve during LC, even though our results had no statistical significance. For including all steps of LC, some modifications (trocar insertion and specimen evacuation) are required.
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