title: Safety and Efficacy of Laparoscopic Access in a Surgical Training Program.
abstract: Our study evaluated outcomes of laparoscopic access in a surgical residency program and identified variables associated with adverse outcomes. Following IRB approval, we reviewed prospectively collected data from consecutive laparoscopic surgeries from a single surgeon August 2008 to November 2011. Descriptive statistics were generated, and successful and unsuccessful access techniques were compared using the t test, Fisher exact test, and χ test of independence, with P<0.05 considered significant. Five hundred consecutive laparoscopic surgeries were evaluated; the average patient age was 47 years and 55% of patients were female. The most common procedures included laparoscopic cholecystectomy (29%), laparoscopic ventral hernia (15%), laparoscopic appendectomy (12%), laparoscopic colon/small bowel (11%), and laparoscopic inguinal hernia (10%). Successful laparoscopic access was obtained in 98% of patients. The most common access techniques were umbilical stalk technique (57%) and Veress followed by optical trocar technique (29%). The complication rate was 7% and included multiple access attempts in 3.4%, attending physician having to take over access in 1.6%, bleeding/solid organ injury in 0.8%, insufflating peritoneum in 0.6%, and bowel injury in 0.2%. There was a significant relationship between entry technique and failure rate. Open cutdown away from umbilicus had a higher failure rate than other techniques (P=0.0002). There was also a significant relationship between type of surgery and failure rate of technique, with laparoscopic ventral hernia and laparoscopic small bowel cases having the highest failure rate (P=0.005). We observed no difference in success rate based on age, sex, race, previous surgery, and resident training level (P>0.05). Laparoscopic access using appropriate techniques can be safely performed in a residency training program. Laparoscopic ventral hernia and small bowel procedures for obstruction can be difficult cases to obtain access, and surgeons should be able to use multiple strategies to obtain access.
authors.affiliation: Department of Surgery, South East Area Health Education Center, New Hanover Regional Medical Center, Wilmington, NC.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Johnson
authors.forename: William B
authors.initials: WB
authors.lastname: Hooks
authors.forename: Ashley
authors.initials: A
authors.lastname: Adams
authors.forename: William W
authors.initials: WW
authors.lastname: Hope
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D010535:Laparoscopy / Q000009:adverse effects / Q000193:education* / Q000379:methods; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000592:standards*; D011446:Prospective Studies; D055815:Young Adult