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Minimal access surgery began in the early 1980s with the introduction of laparoscopic fallopian tube ligation. The first laparoscopic cholecystectomy was performed 7 years later, and was rapidly embraced as the preferred way of cholecystectomy despite a lack of evidence to support the safety from the new technique in the incidence of mistakes and errors in minimal access surgery is never documented.
In response to several deaths and complications associated with laparoscopic cholecystectomy, the brand new York State Department of Health issued guidelines for that credentialing of surgeons who wished to perform the process. At the same time frame, a National Institutes of Health Consensus conference published recommendations regarding indications for laparoscopic cholecystectomy.
Clinical trials comparing the laparoscopic procedure along with other approaches eventually says the newer procedure to be less morbid than traditional open cholecystectomy, as well as mini-laparotomy. Importantly, though, it also became clear that acquiring the skills to do this new procedure involved a substantial surgical"learning curve. This learning curve no more affects patients undergoing laparoscopic cholecystectomy, as training has become a required part of all surgical residency programs, with graduating surgery residents typically having performed more than 50 laparoscopic cholecystectomies.
However, the growth of laparoscopic cholecystectomy continues to be then equally rapid development and using minimal access procedures in just about any surgical specialty. This chapter considers the individual safety issues that arise with the diffusion of a new procedurally-based technology. It highlights the"learning curve" inherent in any new procedure, as competence invariably grows with more experience. Because it is so widely performed and has the largest literature describing its record, this chapter focuses on lessons learned in the introduction of laparoscopic cholecystectomy.