Abstract
Background: Single-incision laparoscopic appendectomy (SILA) has become an accepted alternative to conventional multiport laparoscopic appendectomy. Yet, little is known about the impact of operations performed by residents on the outcome of SILA. The aim of the present study was to evaluate the safety and efficacy of SILA performed by younger surgeons. Methods: All SILA's at a single institution were reviewed and grouped according to the educational level of the operating surgeon: group 1 included residents with no experience in single-incision laparoscopic surgery (SILS) and little experience in multiport laparoscopy, group 2 comprised fellows with experience in multiport laparoscopy but with no experience in SILS, and group 3 consisted of senior surgeons, all of whom were experienced in performing SILS. Results: A total of 176 patients were included. The patients had been operated on by residents (n=62), fellows (n=21), or senior surgeons (n=93). Senior surgeons performed the operation in less time than fellows or residents (48.7 vs. 55.4 vs. 53.6 minutes, respectively; p=0.108). Six patients required conversion to multiport laparoscopy while no patient required conversion to the open procedure. The overall postoperative morbidity was 9.1%, with no significant difference between the three groups (p=0.536). The surgeon's level of surgical education was no statistical risk factor for developing postoperative complications after SILA. Conclusion: Although operating times were longer for residents and fellows compared to senior surgeons, less surgical experience did not correlate with a greater need for conversion to multiport laparoscopy and was not associated with a higher rate of postoperative complications.
Highlights
Over the last thirty years, laparoscopic appendectomy has gained wide acceptance as the surgical procedure of choice for patients with acute or chronic appendicitis
As senior surgeons are becoming increasingly familiar with the technique, it is being incorporated in surgical training as well
The mean operating time required by senior surgeons was 48.7 ± 17.2 minutes, followed by residents (53.6 ± 15.7 minutes) and fellows (55.4 ± 20.5 minutes), but the difference did not achieve statistical significance (p=0.108)
Summary
Over the last thirty years, laparoscopic appendectomy has gained wide acceptance as the surgical procedure of choice for patients with acute or chronic appendicitis. A shorter hospital stay, earlier return to work and activity, better wound healing, and less postoperative pain are well known reasons for the transition from laparotomy to laparoscopy. These benefits raise the question as to whether more minimalized surgery would offer patients even greater benefits. Single-incision laparoscopic surgery (SILS) has raised tremendous interest among surgeons in the last few years, and has emerged as a serious alternative to conventional multiport laparoscopy. Little is known about the impact of operations performed by residents on the outcome of SILA. The aim of the present study was to evaluate the safety and efficacy of SILA performed by younger surgeons
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