Safety of Totally Implantable Venous Access Port Implantation Performed by Residents via the Percutaneous Subclavian Vein Approach

Abstract Background Totally implantable venous access ports (TIVAPs) are widely used for long-term intravenous therapies. The safety of TIVAP implantation performed primarily by surgical residents remains a subject of debate, particularly when using the percutaneous subclavian vein approach. Aims Primary aim was to assess the safety of TIVAP implantation performed by residents via the percutaneous subclavian vein approach and to compare complication rates across different levels of surgical supervision. Methods Retrospective single-center study included all consecutive adult patients undergoing TIVAP implantation between January 2015 and June 2024. A total of 1075 procedures were analyzed. Five surgeon groups were defined: resident alone, junior plus senior resident, resident with secondary attending support, resident with attending surgeon and attending surgeon alone. The primary endpoint was any complication including pneumothorax, hemothorax, failed catheter insertion, primary catheter dysfunction or early infection. Secondary endpoints were late infections (90 days) and secondary catheter dysfunction. Crude and adjusted logistic regression analyses were performed, adjusting for relevant patient -and procedure-related confounders. Results Mean patient age was 59±14 years, and 79% were female (Table.1). Residents performed 42.9% of procedures independently. Percutaneous subclavian vein technique was used in 95% of cases (Table.2). Pneumothorax occurred in 2.1% of patients, chest tube insertion in 1.0%, and no hemothorax was observed (Table.3). Overall complication rates did not differ significantly between surgeon groups after adjustment (Figure.2). Residents operating independently showed no increased risk compared with attending surgeons (Figure.2). Pneumothorax was most frequent in cases requiring secondary attending support (Figure.1). Independent predictors of complications included higher body mass index, anticoagulation, immunosuppression, and pre-existing venous devices (Figure.3). Conclusion TIVAP implantation via the percutaneous subclavian vein can be performed safely by residents within a structured training and supervision framework. Comparable complication rates to attending surgeons support resident autonomy, while increased complications in assisted cases likely reflect higher procedural complexity rather than insufficient experience.For image description, please refer to the figure legend and surrounding text.