Key result
Laparoscopic approaches dominated general surgery resident experience for appendectomies (95.6%) and cholecystectomies (83.9%), resulting in unequal exposure to open procedures.
Why the study?
Laparoscopic surgery has altered residency training, leaving traditional open procedures less familiar to general surgery residents; this study investigated how open operative experience compares with laparoscopy.
How does open operative experience compare with laparoscopy for general surgery residents?
Cohort (n=777)
Yes
How does open operative experience compare with laparoscopy for general surgery residents?
General surgery residents have significantly less exposure to open appendectomies and cholecystectomies compared to laparoscopic approaches, suggesting a need for competency-based training for low-volume open cases.
May limit resident open-case competency; leaves open optimal training models for laparoscopic-dominant eras.
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.
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Melmer et al. (2019) conducted a cohort in Surgical intervention involving the appendix and gallbladder (n=777). Laparoscopic surgery vs. Open surgery was evaluated on Proportion of laparoscopic versus open procedures. Laparoscopic approaches dominated general surgery resident experience for appendectomies (95.6%) and cholecystectomies (83.9%), resulting in unequal exposure to open procedures.
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