Learning Curve for Laparoscopic Surgery

Dear Editor, We have gone through the article "feasibility of safe laparoscopic surgery performed by junior residents (JRs) without exposure of open appendectomy: A retrospective study" published in Journal of Family Medicine and Primary Care, February 2022, Volume 11, Issue 2, with a lot of interest.[1] They have conducted retrospective analysis of Laparoscopic appendectomy performed by two groups of surgeon, i.e., JRs and senior residents (SRs). The result shows that there was no significant difference in operative time (84.87 ± 24.73 vs. 86.95 ± 24.93, P = 0.679), intraoperative complication (9.2% vs. 7.8%, P = 0.769), postoperative complications (34.2% vs. 34.4%, P = 0.984), conversion to open (6.6% vs. 4.7%, P = 0.633), length of postoperative hospital stay (2.3 ± 2 vs. 2.2 ± 1, P = 0.739), and readmission (4% vs. 3%, P = 0.794) among both the groups. It was mentioned that SRs had the experience of both open and laparoscopic appendectomy for 3–5 years, while JRs had no/less experience of open appendectomy. This study depicts that there is no or minimal need of experience of open surgery to perform laparoscopic surgery. However, in this article, they have not mention that what was the total number of JRs and SRs, who involved in this study. The number of participants in this study may be of high importance as more cases might be performed by few surgeons only in any group, which may bias the finding of the research. They should also produce the average number of surgeries performed by surgeons in each group. The study duration of this cross-sectional study was from May 2018 to May 2020, which includes about 6 month periods of the first wave of the COVID-19 pandemic in India. During this period, elective surgeries were minimal in hospitals. In the discussion part, it is clear that authors have totally different results from the previous studies. Though, we would like to add something more nearby the results of this study. This is true that in the modern era, minimal access surgery (MAS) is replacing the need of open surgeries. The surgical training to new residents may be challenging as the availability of open surgery cases in routine practice. Laparoscopic training is, however, more difficult due to technical glitches like hand-eye coordination, limited vision of the operative field, two-dimensional work area, etc., There are many ways to impart this training like dry laboratories, virtual reality simulators, laparo-trainers, robotic surgery simulators, animal and cadaver model laboratory, and so on.[2] Results of some studies are in favor of rising trend of MAS and declining pattern of exposure of open surgery to trainee residents.[3] Another study suggests that due to extraordinary eye–hand coordination and visuospatial cognitive ability, new-generation residents who have better gaming skills have an edge over laparoscopic skills.[4] As there is lesser exposure of open procedures to newer generations, they have more adaptability and acceptability toward technical skills. Nevertheless, major gastrointestinal surgeries like liver transplant, etc., require much superior training to performers due significant complications involved.[5] MAS training or fellowship programs may improve the outcome in simple and easy laparoscopic procedures also.[6] However, the importance of training of open surgical procedures cannot be bypassed, which will be ultimately required in conversion cases. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.