title: Unsupervised laparoscopic appendicectomy by surgical trainees is safe and time-effective.
abstract: OBJECTIVE
  Open appendicectomy is the traditional standard treatment for appendicitis. Laparoscopic appendicectomy is perceived as a procedure with greater potential for complications and longer operative times. This paper examines the hypothesis that unsupervised laparoscopic appendicectomy by surgical trainees is a safe and time-effective valid alternative.
  
  
  METHODS
  Medical records, operating theatre records and histopathology reports of all patients undergoing laparoscopic and open appendicectomy over a 15-month period in two hospitals within an area health service were retrospectively reviewed. Data were analysed to compare patient features, pathology findings, operative times, complications, readmissions and mortality between laparoscopic and open groups and between unsupervised surgical trainee operators versus consultant surgeon operators.
  
  
  RESULTS
  A total of 143 laparoscopic and 222 open appendicectomies were reviewed. Unsupervised trainees performed 64% of the laparoscopic appendicectomies and 55% of the open appendicectomies. There were no significant differences in complication rates, readmissions, mortality and length of stay between laparoscopic and open appendicectomy groups or between trainee and consultant surgeon operators. Conversion rates (laparoscopic to open approach) were similar for trainees and consultants. Unsupervised senior surgical trainees did not take significantly longer to perform laparoscopic appendicectomy when compared to unsupervised trainee-performed open appendicectomy.
  
  
  CONCLUSIONS
  Unsupervised laparoscopic appendicectomy by surgical trainees is safe and time-effective.
authors.affiliation: Department of Surgery, Central Coast Area Health Service, Gosford, Australia. kennethwo@yahoo.com
authors.forename: Kenneth
authors.initials: K
authors.lastname: Wong
authors.forename: Tristram
authors.initials: T
authors.lastname: Duncan
authors.forename: Andrew
authors.initials: A
authors.lastname: Pearson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome