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Recent data suggest a wide range of conversion (4.9–20%) from laparoscopic (LC) to open cholecystectomy (OC) despite increasing surgeon familiarity and superior equipment. Previously identified risk factors for conversion include increased age, male gender, diabetes, and emergent surgeries. Recent studies also suggest that formal minimally invasive surgical training (MIST) reduces conversion rates. We sought to determine conversion rates in our population, a rural academic medical center, and identify any significant risks for conversion. We conducted a single-center retrospective review of 2810 cholecystectomies performed over a seven-year period (2009–2016). Our study included 837 (29.8%) males and 1973 (70.2%) females with a mean age of 49.2 years. Forty-two percent of cases were done by surgeons with MIST. A total of 139 (4.95%) cases were converted to OC. Univariate predictors of conversion to OC included male gender, age ≥65, urgent and emergent admissions, and MIST of the surgeon. In multivariate modeling, which included significant univariate predictors of conversion, independent predictors of conversion to OC included urgent or emergent admission, male gender, and age ≥65. MIST status was no longer a significant predictor. Our conversion rate from LC to OC falls within the lower range of recently published rates. This is likely multifactorial, and reflects increasing familiarity of the laparoscopic technique, improved quality of laparoscopic equipment, and/or prior knowledge of preoperative risk factors for conversion. Our results, consistent with previous literature, show a reduced conversion rate among surgeons with MIST. This finding, albeit not significant on multivariate analysis, may offer insight into a potential alterable preoperative risk factor for conversion and warrants further research. Further knowledge about the impact MIST has on conversion may provide a feasible preoperative approach to reducing conversion to OC, thereby reducing costs and overall patient morbidity.

Cholecystectomy is one of the most commonly performed general surgery procedures in the USA. It is most frequently performed for benign biliary disease such as biliary colic or cholecystitis; however, resected specimens are frequently sent for histopathological analysis due to the perceived risk of incidental gallbladder carcinoma (iGBC). The principle aim of this study is to review the pathology results from gallbladder specimens sent for routine pathology, determine the incidence of iGBC in our population, and determine whether surgeons need to send specimens for further analysis if no preoperative or intraoperative suspicion for malignancy is present. We performed a large single-center case-controlled retrospective study of all gallbladder specimens sent for routine histopathological analysis between 2009 and 2014. The results were tabulated, including both common and rare findings. We then analyzed patient outcomes and survival for the case group of iGBC patients and determined value in life years (LY) gained per dollar spent on pathological screening. A total of 2153 pathology reports were reviewed. After exclusion criteria, a total of 1984 were included in data analysis. The incidence of iGBC was 0.25 % (95 % CI 0.08, 0.59), and dysplasia was 0.70 % (0.39, 1.20). The most common pathological findings included chronic cholecystitis in 89 % (87.4, 90.3) and cholelithiasis in 81 % (79.1, 82.6) of specimens. Total charges for pathological screening were $65,404 per LY to date; however, two patients have ongoing disease-free survival and this figure is expected to decrease. The incidence of significant pathology necessitating change in clinical management is extremely low in our population. Despite this, the cost per LY gained from routine pathological analysis appears to be of sufficient value to continue with current practice. Alternatively, selective screening based on risk factors, intraoperative findings, and on-table examination of specimen may be a more cost-effective approach.