title: Transumbilical laparoscopic appendectomy performed by residents is safe and feasible.
abstract: BACKGROUND
  The aim of this study was to compare the clinical outcomes of single-incision transumbilical laparoscopy-assisted appendectomy performed by surgical residents and attending surgeons.
  
  
  METHODS
  We reviewed the clinical outcomes of 131 transumbilical laparoscopy-assisted appendectomies performed from January 2011 to June 2014. During the study period, 13 residents and 6 board-certified attending surgeons performed the procedures. For all operations performed by residents and attending surgeons, we reviewed and compared gender, age, BMI, body temperature, white blood cell count, C-reactive protein serum level, and the presence of a fecalith or abscess. Clinical outcomes including operative time, estimated blood loss, need for additional ports, conversion to open surgery, intraoperative complications, postoperative complications, and postoperative hospital stay were compared between the two groups.
  
  
  RESULTS
  The mean preoperative white blood cell count in the resident-operated group was significantly higher than in the attending-operated group (14.0 vs 10.8 ×103/mm3, P = 0.007). There were no other significant differences in clinical variables between the two groups. Outcomes show that estimated blood loss was significantly higher (23.4 vs 9.8 mL, P = 0.031) and operative time tended to be longer (86.0 vs 72.0 min, P = 0.056) in the resident-operated group. No other significant differences were observed.
  
  
  CONCLUSIONS
  Transumbilical laparoscopy-assisted appendectomy performed by residents is feasible and safe. It is an acceptable as a part of routine surgical training.
authors.affiliation: Jichi Medical University, Department of Surgery, Tochigi, Japan. kendo@jichi.ac.jp.|Saiseikai Utsunomiya Hospital, Department of Surgery, Tochigi, Japan. kendo@jichi.ac.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Endo
authors.affiliation: Keio University Hospital, Department of Emergency Medicine, Tokyo, Japan.|Saiseikai Utsunomiya Hospital, Department of Surgery, Tochigi, Japan.
authors.forename: Dai
authors.initials: D
authors.lastname: Kujirai
authors.affiliation: Keio University Hospital, Department of Surgery, Tokyo, Japan.|Saiseikai Utsunomiya Hospital, Department of Surgery, Tochigi, Japan.
authors.forename: Hinako
authors.initials: H
authors.lastname: Maeda
authors.affiliation: Saiseikai Utsunomiya Hospital, Department of Surgery, Tochigi, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishida
authors.affiliation: Saiseikai Utsunomiya Hospital, Department of Surgery, Tochigi, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Terauchi
authors.affiliation: Saiseikai Utsunomiya Hospital, Department of Surgery, Tochigi, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kimata
authors.affiliation: Saiseikai Utsunomiya Hospital, Department of Surgery, Tochigi, Japan.
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Shinozaki
authors.affiliation: Jichi Medical University, Department of Surgery, Tochigi, Japan.
authors.forename: Alan Kawarai
authors.initials: AK
authors.lastname: Lefor
authors.affiliation: Jichi Medical University, Department of Surgery, Tochigi, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Sata
mesh_terms: D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome; D014472:Umbilicus; D055815:Young Adult
keywords: Appendectomy; laparoscopic surgery; surgical education