Learning curve after rapid introduction of laparoscopic appendectomy: are there any risks in surgical resident participation?

Eszter Mán,Zsolt Simonka,Tibor Németh,Tibor Géczi,György Lázár

doi:10.1186/s13017-016-0074-5

Eszter Mán, Zsolt Simonka + Show 3 more

Open Access

https://doi.org/10.1186/s13017-016-0074-5

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Abstract

BackgroundWith the spread of the minimally invasive technique, laparoscopic appendectomy (LA) is performed with increasing frequency with excellent results. The method provides surgical residents with an excellent opportunity to learn basic laparoscopic skills and prepares them for more complex interventions.MethodsWe evaluated the results of 600 laparoscopic appendectomies performed by 5 surgical residents (Group A) and 5 consultant surgeons (Group B) between 2006 and 2009. Comparing the two groups based on patient demographics, duration of surgery, operation time depending on the severity of inflammation, intraoperative blood loss, conversion rate, hospital stay in days, and postoperative complications. We also assessed the extent to which the minimum of 20 surgeries to be performed in the learning curve period as recommended by the EAES corresponds to our experience. SPPS 20 was used for the statistical analysis.ResultsSix hundred laparoscopic appendectomies were performed in the study period (Group A: n = 319; Group B: n = 281). A significant difference was found between the two groups in duration of surgery during the learning curve period and when comparing the duration of LA surgeries in the learning curve period with the duration of later surgeries in both groups. The operation time in case of more severe inflammation also showed a significant difference when comparing with simple appendicitis operation time.ConclusionsThe rapid introduction of laparoscopy involves few risks, the surgery is also performed with sufficient safety by surgical residents, and it provides them with an excellent opportunity to learn the basic laparoscopy skills.

Highlights

With the spread of the minimally invasive technique, laparoscopic appendectomy (LA) is performed with increasing frequency with excellent results
The groups were compared based on general patient demographics, duration of surgery, operation time depending on the severity of inflammation, intraoperative blood loss, conversion rate, hospital stay in days, negative appendectomy rate, and number of complications
In Group A, conversion was required in 18 cases (5.6 %), while this number was 21 (7.4 %) in Group B

Summary

Introduction

With the spread of the minimally invasive technique, laparoscopic appendectomy (LA) is performed with increasing frequency with excellent results. The method provides surgical residents with an excellent opportunity to learn basic laparoscopic skills and prepares them for more complex interventions. In many Western countries, appendectomies outside the day-shift hours are performed by surgical residents under the supervision of a consultant [4]. This is the first type of laparoscopic surgery residents learn; they learn the basics of the minimally invasive surgical technique and may develop the basic skills they can use in later, more complex surgeries [5]

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