Impact of Laparoscopy on Training: Are Open Appendectomy and Cholecystectomy on the Brink of Extinction?

• Published in: The American surgeon 2019-07, Vol.85 (7), p.761-763
• Main Authors: Melmer, Patrick D., Chaconas, Christen, Taylor, Ryan, Verrico, Elizabeth, Cockcroft, April, Pinnola, Aaron, Holmes, Sharon, Sciarretta, Jason D., Davis, John Mirhan
• Format: Article
• Language: English
• Subjects: Appendectomy; Appendectomy - methods; Appendix; Bile ducts; Biological evolution; Cholecystectomy; Cholecystectomy - methods; Cholecystectomy, Laparoscopic - education; Cholecystectomy, Laparoscopic - statistics & numerical data; Clinical Competence; Endoscopy; Exploration; Familiarity; Gallbladder; Graduate studies; Humans; Internship and Residency - statistics & numerical data; Laparoscopy; Laparoscopy - education; Retrospective Studies; Skills; Studies; Surgery; Surgical outcomes; Training; Trends
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481908500739

The operative experience of present-day surgical residency training has evolved as a result of the contributions of laparoscopic surgery. Some traditional open procedures are now more descriptive and less of a familiarity to many general surgery residents (GSRs). The aim of this study was to investigate how open operative experience compares with laparoscopy for GSRs. A retrospective, multicenter, consecutive cohort study of all patients undergoing surgical intervention involving the appendix and gallbladder identified from the ACS-NSQIP database over a 2.5-year period. All GSR postgraduate year-level operative experience was recorded. Of 777 procedures, 13 laparoscopic appendectomy conversions to open (4.3%) by Rocky-Davis (15%) or lower midline (84.6%) incisions were performed versus 285 that remained laparoscopic (95.6%). Fifty (10.4%) open cholecystectomies (38 open + 10 conversions + 2 common bile duct (CBD) exploration), 27 (5.6%) laparoscopic cholecystectomies with cholangiogram, and 402 (83.9%) laparoscopic cholecystectomies were performed. Twenty-nine different GSRs participated in procedures. Eighty-five (10.9%) operations were performed with multi–postgraduate year levels. Surgical residents have an unequal operative experience for case-specific open procedures. A competency-based system to demonstrate a resident's hands-on surgical skills is fundamental to residency training and should be considered for specific types of low-volume open surgical cases.