title: A national review of the frequency of minimally invasive surgery among general surgery residents: assessment of ACGME case logs during 2 decades of general surgery resident training.
abstract: OBJECTIVE
  Minimally invasive surgery (MIS) has created a shift in how many surgical diseases are treated. Examining the effect on resident operative experience provides valuable insight into trends that may be useful for restructuring the requirements of resident training.
  
  
  OBJECTIVE
  To evaluate changes in general surgery resident operative experience regarding MIS.
  
  
  METHODS
  Retrospective review of the frequency of MIS relative to open operations among general surgery residents using the Accreditation Council for Graduate Medical Education case logs for academic years 1993-1994 through 2011-2012.
  
  
  METHODS
  General surgery residency training among accredited programs in the United States.
  
  
  METHODS
  We analyzed the difference in the mean number of MIS techniques and corresponding open procedures across training periods using 2-tailed t tests with statistical significance set at P < .05.
  
  
  RESULTS
  Of 6,467,708 operations with the option of MIS, 2,393,030 (37.0%) were performed with the MIS approach. Of all MIS operations performed, the 5 most common were cholecystectomy (48.5%), appendectomy (16.2%), groin hernia repair (10.0%), abdominal exploration (nontrauma) (4.4%), and antireflux procedures (3.6%). During the study period, there was a transition from a predominantly open to MIS approach for appendectomy, antireflux procedures, thoracic wedge resection, and partial gastric resection. Cholecystectomy is the only procedure for which MIS was more common than the open technique throughout the study period (P < .001). The open approach is more common for all other procedures, including splenectomy (0.7% MIS), common bile duct exploration (24.9% MIS), gastrostomy (25.9% MIS), abdominal exploration (33.1% MIS), hernia (20.3% MIS), lung resection (22.3% MIS), partial or total colectomy (39.1%), enterolysis (19.0% MIS), ileostomy (9.0% MIS), enterectomy (5.2% MIS), vagotomy (1.8% MIS), and pediatric antireflux procedures (35.9% MIS); P < .001.
  
  
  CONCLUSIONS
  Minimally invasive surgery has an increasingly prominent role in contemporary surgical therapy for many common diseases. The open approach, however, still predominates in all but 5 procedures. Residents today must become efficient at performing multiple techniques for a single procedure, which demands a broader skill set than in the past.
authors.affiliation: Department of Surgery, University of Washington School of Medicine, Seattle.
authors.forename: Morgan K
authors.initials: MK
authors.lastname: Richards
authors.affiliation: Department of Surgery, University of Washington School of Medicine, Seattle.
authors.forename: Jarod P
authors.initials: JP
authors.lastname: McAteer
authors.affiliation: Department of Surgery, University of Washington School of Medicine, Seattle.
authors.forename: F Thurston
authors.initials: FT
authors.lastname: Drake
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
authors.affiliation: Department of Surgery, University of Washington School of Medicine, Seattle.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Khandelwal
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Gow
mesh_terms: D000068:Accreditation; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States