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The impact of a resident’s seniority on operative time and length of hospital stay for laparoscopic appendectomy: outcomes used to measure the resident’s laparoscopic skills

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Abstract

Background

Laparoscopic appendectomy (LA) frequently is performed by residents during calls. This study aimed at evaluating residents’ surgical skills using parameters of operating time, length of hospital stay (LOS), and conversion rate in correlation with the operating team’s level of seniority. In addition, this study compared the operating time for LA with that for open appendectomy performed by the same teams, and identified deterministic factors that have an impact on such parameters.

Methods

All records of patients undergoing appendectomy performed by residents alone during a 32-month period were reviewed retrospectively. Eight residents were assigned to two levels of seniority: juniors ≤3 years (J) and seniors >3 years (S). Operating time and LOS were compared between the three surgical teams, namely, J/J, J/S, and S/J as operating and assistant surgeons, respectively. Operating time, conversion rates, and LOS were compared for the same team combinations.

Results

Residents alone performed 341 (151 laparoscopic and 190 open) appendectomies during on-call hours. Four of the residents had been 3 years or less in residency (J), and four had been in residency more than 3 years (S). The overall mean operating time was 1.33 ± 0.48 h for LA and 1.2 ± 0.5 h for open appendectomy (p = 0.016). The operating time correlated with the level of training for both LA (J/J, 1.6 ± 0.38 h; J/S, 1.41 ± 0.37 h; S/J, 1. 25 ± 0.4 h; p = 0.03, ANOVA) and open appendectomy (J/J, 1.53 ± 0.89 h; J/S, 1.4 ± 0.63 h; S/J, 0.86 ± 0.45 h; p = 0.023, ANOVA). The mean LOS was 2.9 ± 3.1 days for open appendectomy and 2.1 ± 2.8 days for LA (p = 0.065), and was not different after operation by any of the teams (J/J, J/S, S/J) for either the open or the laparoscopic procedure.

Conclusions

There is a distinct difference in the surgical skills of residents according to level of seniority, as primarily reflected by operating time. Laparoscopic appendectomy requires longer time to perform in a teaching setting, but the most deterministic factor that dictates operating time is the composition of the surgical team rather than the laparoscopic approach.

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References

  1. FJ Branicki (2002) ArticleTitleAbdominal emergencies: diagnostic and therapeutic laparoscopy Surg Infect (Larchmt) 3 (3) 269–282

    Google Scholar 

  2. P Cervini LC Smith DR Urbach (2002) ArticleTitleThe surgeon on call is a strong factor determining the use of a laparoscopic approach for appendectomy Surg Endosc 16 1774–1777

    Google Scholar 

  3. YP Cho SM Jung MS Han HJ Jang JS Kim YH Kim SG Lee (2003) ArticleTitleRole of diagnostic laparoscopy in managing acute mesenteric venous thrombosis Surg Laparosc Endosc Percutan Tech 13 215–217

    Google Scholar 

  4. RL Coleman CY Muller (2002) ArticleTitleEffects of a laboratory-based skills curriculum on laparoscopic proficiency: a randomized trial Am J Obstet Gynecol 186 836–842

    Google Scholar 

  5. GW Cundiff (1997) ArticleTitleAnalysis of the effectiveness of an endoscopy education program in improving residents’ laparoscopic skills Obstet Gynecol 90 854–859

    Google Scholar 

  6. H Dagash M Chowdhury A Pierro (2003) ArticleTitleWhen can I be proficient in laparoscopic surgery? A systematic review of the evidence J Pediatr Surg 38 720–724

    Google Scholar 

  7. E Eypasch S Sauerland R Lefering EA Neugebauer (2002) ArticleTitleLaparoscopic versus open appendectomy: between evidence and common sense Dig Surg 19 518–522 Occurrence Handle10.1159/000067608 Occurrence Handle12499748

    Article  PubMed  Google Scholar 

  8. SA Fraser DR Klassen LS Feldman GA Ghitulescu D Stanbridge GM Fried (2003) ArticleTitleEvaluating laparoscopic skills Surg Endosc 17 964–967 Occurrence Handle10.1007/s00464-002-8828-4

    Article  Google Scholar 

  9. TP Grantcharov L Bardram P Funch-Jensen J Rosenberg (2003) ArticleTitleLearning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills Am J Surg 185 146–149 Occurrence Handle10.1016/S0002-9610(02)01213-8 Occurrence Handle12559445

    Article  PubMed  Google Scholar 

  10. A Hawasli R Featherstone L Lloyd M Vorhees (1996) ArticleTitleLaparoscopic training in residency program J Laparoendosc Surg 6 171–174

    Google Scholar 

  11. B Kirshtein A Roy-Shapira L Lantsberg S Mandel E Avinoach S Mizrahi (2003) ArticleTitleThe use of laparoscopy in abdominal emergencies Surg Endosc May 6 . .

    Google Scholar 

  12. SI Liu B Siewert V Raptopoulos RA Hodin (2002) ArticleTitleFactors associated with conversion to laparotomy in patients undergoing laparoscopic appendectomy J Am Coll Surg 194 298–305

    Google Scholar 

  13. M Marzouk M Khater M Elsadek A Abdelmoghny (2003) ArticleTitleLaparoscopic versus open appendectomy Surg Endosc 17 721–724

    Google Scholar 

  14. PH McCormick WA Tanner FB Keane S Tierney (2003) ArticleTitleMinimally invasive techniques in common surgical procedures: implications for training Ir J Med Sci 172 27–29

    Google Scholar 

  15. M Milewczyk M Michalik M Ciesielski (2003) ArticleTitleA prospective, randomized, unicenter study comparing laparoscopic and open treatments of acute appendicitis Surg Endosc . .

    Google Scholar 

  16. JG Peiser D Greenberg (2002) ArticleTitleLaparoscopic versus open appendectomy: results of a retrospective comparison in an Israeli hospital Isr Med Assoc J 4 91–94

    Google Scholar 

  17. S Sauerland R Lefering EA Neugebauer (2002) ArticleTitleLaparoscopic versus open surgery for suspected appendicitis Cochrane Database Syst Rev 1 .

    Google Scholar 

  18. CD Smith TM Farrell SS McNatt RE Metreveli (2001) ArticleTitleAssessing laparoscopic manipulative skills Am J Surg 181 547–550

    Google Scholar 

  19. KJ Sweeney FB Keane (2003) ArticleTitleMoving from open to laparoscopic appendicectomy Br J Surg 90 257–258

    Google Scholar 

Download references

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Shabtai, M., Rosin, D., Zmora, O. et al. The impact of a resident’s seniority on operative time and length of hospital stay for laparoscopic appendectomy: outcomes used to measure the resident’s laparoscopic skills. Surg Endosc 18, 1328–1330 (2004). https://doi.org/10.1007/s00464-003-9216-4

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  • DOI: https://doi.org/10.1007/s00464-003-9216-4

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