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September 15, 1993

Climbing 'The Learning Curve': New Technologies, Emerging Obligations

Author Affiliations

From the Department of Professional Liability & Insurance, American Medical Association, Chicago, Ill.

JAMA. 1993;270(11):1364-1365. doi:10.1001/jama.1993.03510110104041

First performed in France in 1987 and in the United States in 1988, laparoscopic cholecystectomy rapidly became the prevailing treatment of symptomatic gallstones. The National Institutes of Health estimated that as of September 1992 approximately 15000 surgeons in this country have received some training in the procedure and that 80% of gallbladder removals are now done with this technique.1 It is notable that no large randomized trials comparing laparoscopic techniques with the established open cholecystectomy procedure have been done or are being planned. Patient demand for the most advanced technology—and its promise of less postoperative pain and shorter recovery time—drove implementation of the modality faster than prospective research could be done.2 The data that have emerged indicate that complications occur infrequently, prompting the majority of an American Medical Association Diagnostic and Therapeutic Technology Assessment (DATTA) panel3 and a National Institutes of Health consensus conference1 to characterize