A Solution to the Decreased Resident Exposure to Open Operations in the Era of Minimally Invasive Surgery and Restricted Duty Hours May Be with Organ Procurement and Transplantation Surgery

Abstract

The surgical resident experience regarding open surgical procedures and techniques is being significantly limited by the maturation of minimally invasive surgery (MIS) and duty-hour restrictions. MIS has replaced many open procedures as the current standard of care. As MIS progresses, the surgical residents' access to open surgical techniques will become significantly limited by the lack of exposure to common open operations. The Accreditation Council for Graduate Medical Education (ACGME) database was retrospectively reviewed to quantify and categorize resident experience in self-reported surgical procedures. The United Network for Organ Sharing (UNOS) database was retrospectively reviewed to determine the amount of organ transplants and procurements performed during the study period. Data from 1999-2000 and 2008-2009 were collected and compared. There were dramatic changes between the time periods regarding the transition from the open to the laparoscopic approach for multiple operations. In 2008, there were 23,276 transplanted organs and 29,077 organs procured (7990 multi-organ procurements). However, the graduating general surgery chief residents reported doing an average of 2 organ procurements and 7 organ transplantations over a 5-year period. This provides the opportunity for each graduating chief resident to perform 38 more procurements during their residency. It is imperative for surgical educators to find solutions to safely train the future general surgery residents to perform more surgical techniques in less time. One solution to this problem may lie within the field of organ transplantation and procurement. The field of organ transplantation and procurement may be an untapped resource for valuable exposure to the basic principles of open surgical techniques that are declining due to the advancement of MIS and mandated duty-hour restrictions.