ФОРМУВАННЯ ХІРУРГІЧНОЇ МАЙСТЕРНОСТІ ВИКОНАННЯ ЛАПАРОСКОПІЧНОЇ ХОЛЕЦИСТЕКТОМІЇ У СИСТЕМІ ПІСЛЯДИПЛОМНОГО ТЕМАТИЧНОГО ВДОСКОНАЛЕННЯ ФАХІВЦІВ

Abstract

Laparoscopic cholecystectomy remains the “gold standard” for the treatment of cholecystolithiasis, however, interventions in complex cases are associated with a high risk of iatrogenic injury due to distorted anatomical landmarks. Improving postgraduate surgical education methods is critical for minimizing these risks and implementing the “Critical View of Safety” concept. The study aimed to analyze the dynamics of surgical skill acquisition among attendees of thematic advanced training courses and to evaluate the effectiveness of a standardized training approach. The study included 18 surgical residents. The design involved a comparative analysis of three training stages (T0, T1, T2) using the international Global Operative Assessment of Laparoscopic Skills scale. The program comprised theoretical training, bench-top simulation, and practical surgery on experimental animals. Five domains of proficiency were assessed: depth perception, bimanual coordination, efficiency of movement, tissue handling, and autonomy. Statistical analysis was performed using Jamovi (Welch’s ANOVA, Games-Howell post-hoc test). The implemented training methodology ensured a statistically significant improvement (p < 0.001) across all GOALS scale domains. The “Autonomy” score increased by 4.4-fold, “Efficiency of movement” by 278 %, and “Bimanual coordination” by 3.1-fold. A strong negative correlation (r = -0.816; p < 0.001) was established between the quality of achieving CVS and the number of intraoperative errors, alongside a direct correlation (r = 0.781; p < 0.001) between error frequency and procedure duration. This confirms the effectiveness of the “safe slowness” philosophy, where meticulous anatomical verification minimizes technical errors and facilitates faster skill automation in the future. Systematic training using the objective GOALS scale enhances surgical proficiency by 2.5–4.4 times. Integrating CVS protocols into postgraduate curricula is a prerequisite for ensuring high safety standards in modern laparoscopic surgery, particularly in complex clinical conditions such as obstructive jaundice.