Surgical societies seek control of the “laparoscopic revolution”

The October 1989 American College of Surgeons (ACS) Clinical Congress should be recognized as an important moment in the history of modern surgery. It was at this meeting that much of the enthusiasm for laparoscopic cholecystectomy was generated, triggering what is sometimes referred to as the “laparoscopic revolution” in general surgery. First performed in 1987 by Philippe Mouret, MD, and Prof. François Dubois, MD, in France, two groups in the U.S. also are credited with the independent development of laparoscopic cholecystectomy: Barry McKernan, MD, and William Saye, MD, FACS, Marietta, GA; and Douglas Olsen, MD, and Eddie Reddick, MD, FACS, Nashville, TN.

According to Dr. Olsen, a “pivotal milestone in the development of lap chole” was when he and Dr. Reddick presented videos of the procedure at the 1989 Clinical Congress (oral history interview with the author, May 29, 2018). He recalled, “Where we had the videos playing, Reddick and Olsen announced that they were offering training courses for the new technique and within very short order…every spot was taken.” They held their first formal course a few weeks later in November 1989.

Ongoing concerns about complications

The growing interest in laparoscopic cholecystectomy quickly caused concern among academic surgeons. As a March 1990 editorial in the American Journal of Surgery warned, “Unless restraint and adequate training are pursued as policies by the surgical community, the indiscriminate performance of laparoscopic cholecystectomy will increase the incidence of catastrophic complications or even death.”¹ In the following months, surgical societies, such as the ACS and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), offered recommendations on how to reduce potential complications.

SAGES, for example, issued a statement on the “Granting of privileges for laparoscopic general surgery,” recommending that training in the new procedure should include hands-on laboratory practice and observation of a laparoscopic procedure performed by an experienced surgeon.² It emphasized that “attendance at short courses that do not provide supervised hands-on training is not an acceptable substitute,” suggesting that this problem was relatively common.¹

Because laparoscopic and endoscopic techniques already were used in gynecology and gastroenterology, another concern was that nonsurgeons, untrained in open cholecystectomy, would begin offering the procedure. The ACS thus recommended, “For optimal quality patient care, laparoscopic cholecystectomy should be performed by surgeons who are qualified to perform open cholecystectomy…[and] can treat complications consequent to laparoscopic cholecystectomy.”³ Although increased complications were associated with the procedure in the early days of its adoption, by 1993 at least 80 percent of cholecystectomies in Canada and the U.S. were laparoscopic. Complications have since declined, but efforts to further reduce them continue with programs such as the SAGES Safe Cholecystectomy Task Force.⁴

References

1. Cuschieri A, Berci G, McSherry CK. Laparoscopic cholecystectomy. Am J Surg. 1990;159(3):273.
2. Society of American Gastrointestinal Endoscopic Surgeons. Granting of privileges for laparoscopic general surgery. Am J Surg. 1991;161(3):324-325.
3. American College of Surgeons. Statement on Laparoscopic Cholecystectomy. Bull Am Coll Surg. 1990;75(6):23. Available at: www.facs.org/About-ACS/Statements/9-Laparoscopic-Cholecystectomy. Accessed January 28, 2021.
4. Kohn JF, Trenk A, Kuchta K, et al. Characterization of common bile duct injury after laparoscopic cholecystectomy in a high-volume hospital system. Surg Endosc. 2018;32(3):1184-1191.