title: Learning curve after rapid introduction of laparoscopic appendectomy: are there any risks in surgical resident participation?
abstract: BACKGROUND
  With the spread of the minimally invasive technique, laparoscopic appendectomy (LA) is performed with increasing frequency with excellent results. The method provides surgical residents with an excellent opportunity to learn basic laparoscopic skills and prepares them for more complex interventions.
  
  
  METHODS
  We evaluated the results of 600 laparoscopic appendectomies performed by 5 surgical residents (Group A) and 5 consultant surgeons (Group B) between 2006 and 2009. Comparing the two groups based on patient demographics, duration of surgery, operation time depending on the severity of inflammation, intraoperative blood loss, conversion rate, hospital stay in days, and postoperative complications. We also assessed the extent to which the minimum of 20 surgeries to be performed in the learning curve period as recommended by the EAES corresponds to our experience. SPPS 20 was used for the statistical analysis.
  
  
  RESULTS
  Six hundred laparoscopic appendectomies were performed in the study period (Group A: n = 319; Group B: n = 281). A significant difference was found between the two groups in duration of surgery during the learning curve period and when comparing the duration of LA surgeries in the learning curve period with the duration of later surgeries in both groups. The operation time in case of more severe inflammation also showed a significant difference when comparing with simple appendicitis operation time.
  
  
  CONCLUSIONS
  The rapid introduction of laparoscopy involves few risks, the surgery is also performed with sufficient safety by surgical residents, and it provides them with an excellent opportunity to learn the basic laparoscopy skills.
authors.affiliation: Department of Surgery, University of Szeged, Szőkefalvi-Nagy Béla u. 6, H-6720 Szeged, Hungary.
authors.forename: Eszter
authors.initials: E
authors.lastname: Mán
authors.affiliation: Department of Surgery, University of Szeged, Szőkefalvi-Nagy Béla u. 6, H-6720 Szeged, Hungary.
authors.forename: Tibor
authors.initials: T
authors.lastname: Németh
authors.affiliation: Department of Surgery, University of Szeged, Szőkefalvi-Nagy Béla u. 6, H-6720 Szeged, Hungary.
authors.forename: Tibor
authors.initials: T
authors.lastname: Géczi
authors.affiliation: Department of Surgery, University of Szeged, Szőkefalvi-Nagy Béla u. 6, H-6720 Szeged, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Simonka
authors.affiliation: Department of Surgery, University of Szeged, Szőkefalvi-Nagy Béla u. 6, H-6720 Szeged, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Lázár
keywords: Complications; Laparoscopic surgery; Learning curve; Operative time; Residency