Complex minimally invasive surgery in general surgery training: keeping up with the times

Introduction The Accreditation Council for Graduate Medical Education (ACGME) currently requires graduating chief residents to have participated in 75 complex laparoscopic cases. However, they do not define subcategories. We aim to compare trends in the use of minimally invasive approaches for common general surgery procedures nationally and in training to determine if subcategories in training are necessary to mirror national practice patterns. Methods We analyzed ACGME national case log data from 2015 to 2021 to determine trends in the proportion of common procedures being performed with a minimally invasive approach during general surgery training. Minimally invasive procedures were included if the average number of cases completed during training was ten or greater. We then compared these trends to national trends using the NSQIP and MBSAQIP databases as representative samples of the national practice to determine if the trends were different between the two groups. Results Five procedures were identified for analysis. We found statistically significant differences in the trends for hernia repair (ANCOVA: F = 122.1, df = 1, p < 0.001) and enterectomy (ANCOVA: F = 37.0, df = 1, p < 0.001). There was no statistically significant difference for antireflux (ANCOVA: F = 0.4, df = 1, p = 0.53), colectomy/proctectomy (ANCOVA: F = 4.5, df = 1, p = 0.06), and partial gastrectomy procedures (ANCOVA: F = 0.3, df = 1, p = 0.60). Conclusion The proportion of cases performed with a minimally invasive approach continues to rise every year. Consideration should be given to adapting general surgery training requirements to match this growing practice, particularly for procedures that do not appear to be keeping pace with national trends.