Elective Laparoscopic Cholecystectomy Performed by Residents: Impact on Operative Time and Surgical Outcomes

Background: Operative autonomy is fundamental in general surgery training. Concerns have been raised regarding the adequacy of operative exposure during general surgery residency, with many graduating residents perceived as insufficiently prepared. Reduced opportunities for progressive operative autonomy have been identified as a contributing factor. This study aimed to compare the outcomes of elective laparoscopic cholecystectomies (LCs) performed by residents and by attending surgeons in a Portuguese institution. Methods: A retrospective review of all elective LCs performed between January 2020 and December 2023 was conducted. Demographic, clinical and perioperative variables were collected. Results: A total of 189 elective LCs were included, of which 46.6% were performed by residents in a supervised manner. Baseline demographic and clinical characteristics were comparable between groups. Resident-performed procedures had longer operative times (101 vs. 70 minutes, p = 0.003), while postoperative length of stay was shorter (0 vs. 1 day, p = 0.020). No significant differences were observed in intraoperative findings, conversion to open surgery, major postoperative complications, 30-day readmission or late postoperative outcomes. In multivariable analysis, resident participation remained independently associated with longer operative time (β = 13.46 minutes, p = 0.028), together with BMI >25 kg/m² and gallbladder adhesions. Discussion: Supervised resident participation in elective LCs was independently associated with a modest increase in operative time without increasing perioperative morbidity. These findings support resident autonomy under appropriate supervision and adherence to the national general surgery residency programme, suggesting that the additional operative time is an acceptable trade-off for surgical training while maintaining patient safety.