Decline of open surgical experience for general surgery residents



Minimally invasive surgery is now preferred to open in many surgical procedures. This has led to changes in training to ensure skills acquisition and education in minimally invasive technique. There have been limited data regarding the effect of the number of open procedures being performed in training. The aim of this paper is to examine the relationship in trends for open and laparoscopic procedures performed by general surgery residents.


A retrospective review of the Accreditation Council for Graduate Medical Education publicly available resident case log statistical reports for the academic years from 1999–2000 to 2017–2018 was performed for laparoscopic and open anti-reflux surgery, appendectomy, colectomy, splenectomy, and inguinal hernia repair. The data were grouped by time period and compared to evaluate changes in operative patterns.


The mean number for all (open and MIS) of the selected procedures increased from 159.1 in 2000 to 223.8 in 2018 (40.7%). The mean number of laparoscopic cases increased from 23.6 to 135.6 (462%), and open decreased from 135.5 to 88.2 (− 34.9%). There was a significant decrease in the average number of open procedures performed in each period among anti-reflux operations (3.4, 1.8, 1.5, 0.7, p < 0.01), appendectomy (30.7, 23.4, 13.6, 6.8, p < 0.01), and splenectomy (3.0, 2.0, 1.6, 1.4, p < 0.05); the number of open colectomies decreased significantly from Period 2 to Period 4 (46.1, 38.5, 33.4, p < 0.02). There was a significant increase in the number of laparoscopic procedures performed in each period among appendectomy (13.1, 28.3, 48.9, 58.4, all p < 0.02), colectomy (2.9, 10.1, 19.1, 23.4, all p < 0.01), and inguinal hernia repair (9.7, 14.9, 25.6, 34.1, all p < 0.01).


The number of open procedures performed by general surgery residents continues to decline despite an increase in total cases reported. The reduction in open surgical experience may result in surgeons who lack technical skills to safely complete open procedures.

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Fig. 1


  1. 1.

    Vecchio R, Macfayden BV, Palazzo F (2000) History of laparoscopic surgery. Panminerva Med.

  2. 2.

    Kelley WJ (2008) The evolution of laparoscopy and the revolution in surgery in the decade of the 1990s. JSLS 12(4):351–357

  3. 3.

    Berci G, Morgenstern L (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180(5):638

  4. 4.

    Callery M, Strasberg S, Soper N (1996) Complications of laparoscopic general surgery. Gastrointest Endosc Clin N Am 6(2):423–444

  5. 5.

    Lee WJ, Chan CP, Wang BY (2013) Recent advances in laparoscopic surgery. Asian J Endosc Surg.

  6. 6.

    Vassiliou MC, Dunkin BJ, Marks JM, Fried GM (2010) FLS and FES: comprehensive models of training and assessment. Surg Clin North Am.

  7. 7.

    McCoy AC, Gasevic E, Szlabick RE, Sahmoun AE, Sticca RP (2013) Are open abdominal procedures a thing of the past? An analysis of graduating general surgery residents’ case logs from 2000 to 2011. J Surg Educ.

  8. 8.

    Sirinek KR, Willis R, Schwesinger WH (2016) Who will be able to perform open biliary surgery in 2025? J Am Coll Surg.

  9. 9.

    Schuster KM, Lopez PP, Greene T et al (2008) How can trauma surgeons maintain their operative skills? J Trauma—Inj Infect Crit Care.

  10. 10.

    Kansier N, Varghese TK, Verrier ED, Drake FT, Gow KW (2014) Accreditation council for graduate medical education case log: general surgery resident thoracic surgery experience. Ann Thorac Surg.

  11. 11.

    Neville AL, Nemceff D, Bricker SD, Plurad D, Bongard F, Putnam BA (2012) Open appendectomy: no longer an intern case. Am Surg 78(10):1178–1181

  12. 12.

    Fairfax LM, Christmas AB, Green JM, Miles WS, Sing RF (2010) Operative experience in the era of duty hour restrictions: Is broad-based general surgery training coming to an end? Am Surg 76(6):578–582

  13. 13.

    Quillin RC, Cortez AR, Pritts TA, Hanseman DJ, Edwards MJ, Davis BR (2016) Operative variability among residents has increased since implementation of the 80-hour workweek. J Am Coll Surg.

  14. 14.

    Lagoo J, Pappas TN, Perez A (2014) A relic or still relevant: The narrowing role for vagotomy in the treatment of peptic ulcer disease. Am J Surg.

  15. 15.

    McLaughlin SA (2013) Surgical management of the breast. Breast conservation therapy and mastectomy. Surg Clin North Am.

  16. 16.

    Fonseca AL, Reddy V, Longo WE, Udelsman R, Gusberg RJ (2014) Operative confidence of graduating surgery residents: a training challenge in a changing environment. Am J Surg 207(5):797–805.

  17. 17.

    Campbell BM, Lambrianides AL, Dulhunty JM (2018) Open cholecystectomy: exposure and confidence of surgical trainees and new fellows. Int J Surg. 51:218–222.

  18. 18.

    Brown C, Abdelrahman T, Patel N, Thomas C, Pollitt MJ, Lewis WG (2017) Operative learning curve trajectory in a cohort of surgical trainees. Br J Surg.

  19. 19.

    McCluney AL, Vassiliou MC, Kaneva PA et al (2007) FLS simulator performance predicts intraoperative laparoscopic skill. Surg Endosc 21(11):1991–1995.

  20. 20.

    Steigerwald SN, Park J, Hardy KM, Gillman LM, Vergis AS (2015) Does laparoscopic simulation predict intraoperative performance? A comparison between the Fundamentals of Laparoscopic Surgery and LapVR evaluation metrics. Am J Surg.

  21. 21.

    Mueller CL, Kaneva P, Fried GM, Feldman LS, Vassiliou MC (2014) Colonoscopy performance correlates with scores on the FES™ manual skills test. Surg Endosc.

  22. 22.

    Sonnadara RR, Mui C, McQueen S et al (2014) Reflections on competency-based education and training for surgical residents. J Surg Educ.

  23. 23.

    Swing SR (2007) The ACGME outcome project: retrospective and prospective. Med Teach.

  24. 24.

    Sonnadara RR, Van Vliet A, Safir O et al (2011) Orthopedic boot camp: examining the effectiveness of an intensive surgical skills course. Surgery.

  25. 25.

    Martin M, Vashisht B, Frezza E et al (1998) Competency-based instruction in critical invasive skills improves both resident performance and patient safety. Surgery.

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Correspondence to Emily Steinhagen.

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Dr. Sharon L. Stein is a consultant for Merck Sharp and Dohme Corporation. Dr. Jeffrey Marks is a consultant for the Olympus Corporation, a consultant for the US Endoscopy, a consultant for the Boston Scientific Coropration, and honoria for the Steris Coporation. Drs. Katherine Bingmer, Asya Ofshteyn, and Emily Steinhagen have no conflicts of interest or financial ties to disclose.

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Bingmer, K., Ofshteyn, A., Stein, S.L. et al. Decline of open surgical experience for general surgery residents. Surg Endosc 34, 967–972 (2020).

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  • Laparoscopic surgery
  • Resident education
  • Open surgery