Laparoscopic appendectomy as an initial step in independent laparoscopic surgery by surgical residents.
BACKGROUND
Laparoscopic appendectomy (LA) can be used as a training model for the start of the independent experience of young residents. We tried to evaluate whether LA is a risk factor for patients when it is done by novice surgeons during the different steps of their training.


METHODS
A retrospective study of all the patients who underwent LA in our department between 2000 and 2008 was conducted. The patients were operated on by novice surgeons, chief residents, and senior surgeons. Preoperative variables were compared, as well as surgical outcomes and complications.


RESULTS
During the study period, 477 LA, were performed on 320 women and 157 men, with a mean age of 39 years. In 11 cases (2.3%), the operation was converted. No difference was found in preoperative patient status. There was no difference between groups in the rate of accurate preoperation diagnosis, in comparison with the pathologic report. The rates of conversion, postoperative complications, and negative appendectomies were similar between residents and seniors. These findings were also found in a subgroup analysis, in which we compared each group.


CONCLUSIONS
There is no additional risk in a LA done by a resident, whether a chief or a novice. LA is a good model for training young surgeons in laparoscopic surgery: It enables the young surgeon to engage and lead a real case and does not imbue any risk upon the patient.
Perry
Zvi H
ZH
Department of Surgery A, Soroka University Medical Center, Beer-Sheva, Israel.
Netz
Uri
U
Mizrahi
Solly
S
Lantsberg
Leonid
L
Kirshtein
Boris
B
D000328:Adult; D001062:Appendectomy / Q000009:adverse effects* / Q000193:education* / Q000379:methods; D001064:Appendicitis / Q000601:surgery*; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome