Changing paradigms in minimally invasive surgery training.
BACKGROUND
Realizing the trends toward minimally invasive procedures, the Accreditation Council for Graduate Medical Education (ACGME) increased the requirements for laparoscopic procedures effective 2007 to 2008. Our purpose was to analyze the trend of laparoscopic versus open cases.


METHODS
We analyzed national ACGME general surgery operative log program data for basic and advanced open and laparoscopic procedures performed by graduating surgical residents between academic years 1996 to 1997 and 2009 to 2010.


RESULTS
From 1997 to 2010, the average number of procedures performed by graduating residents increased for appendectomies (36.5 to 59.3), cholecystectomies (90.9 to 112), hernia repairs (58.9 to 67.4), and colectomies (40.1 to 60.2). These increases have been accompanied by decreases in the percentage of open procedures for appendectomies (84% to 30%), cholecystectomies (24% to 9%), hernia repairs (90% to 70%), and colectomies (97% to 71%), which have resulted primarily from a decrease in open procedures (basic) or an increase in laparoscopic procedures (advanced).


CONCLUSIONS
The rising number of laparoscopic procedures performed by surgical residents is associated with a drastic decrease in the number of basic open procedures. Although the number of open procedures is sufficient to meet ACGME requirements for now, this is an area of concern for the adequacy of training in the future.
Department of Surgery, Providence Hospital and Medical Centers, 16001 West 9 Mile Road, Southfield, MI 48075, USA.
Amruta
A
Unawane
Armin
A
Kamyab
Mitesh
M
Patel
Jeffrey C
JC
Flynn
Vijay K
VK
Mittal
D001062:Appendectomy / Q000592:standards; D017081:Cholecystectomy, Laparoscopic / Q000592:standards; D002983:Clinical Competence; D003082:Colectomy / Q000592:standards; D004503:Education, Medical, Graduate / Q000639:trends*; D059685:Herniorrhaphy / Q000592:standards; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000592:standards*; D012189:Retrospective Studies; D013043:Specialties, Surgical