title: Can laparoscopic appendectomy be safely performed by surgical residents without prior experience of open appendectomy?
abstract: BACKGROUND
  As laparoscopic surgery has become the mainstream technique for abdominal surgery, it has become difficult for surgical residents to have opportunities to perform open surgery. This study aimed to examine the appropriateness and feasibility of laparoscopic appendectomy performed by surgical trainees who had little experience with open appendectomy or laparoscopic training with animal models.
  
  
  METHODS
  We retrospectively reviewed all the records of patients who underwent appendectomy for acute appendicitis from April 2008 to December 2014. Residents were assigned to two levels of seniority: junior residents who had undergone 1-3 years of residency and senior residents who had undergone 4-6 years of residency. Patient characteristics, histopathological results, operative time, blood loss, conversion to open procedure, complications, length of hospital stay, and mortality were compared between the two groups.
  
  
  RESULTS
  During the study period, 174 patients with the clinical diagnosis of acute appendicitis underwent laparoscopic appendectomy by junior residents and 90 patients were operated on by senior residents. There were no statistical differences in the characteristics of the patients, conversion rates (0/174 vs. 1/90), median operative times (75 minutes vs. 75 minutes), complication rates (7% vs. 4%), and median lengths of hospital stay (4 days vs. 4 days).
  
  
  CONCLUSIONS
  Laparoscopic appendectomy can be performed safely by surgical residents who had little experience or training with animal models or open appendectomy. In this era of laparoscopic surgery, laparoscopic appendectomy represents an important opportunity for training surgical residents with little experience of open surgery.
authors.affiliation: Department of Digestive Surgery, Colorectal Surgery Unit, Toranomon Hospital Tokyo, Tokyo, Japan. Electronic address: hiramatsu.v05@gmail.com.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Hiramatsu
authors.affiliation: Department of Digestive Surgery, Colorectal Surgery Unit, Toranomon Hospital Tokyo, Tokyo, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Toda
authors.affiliation: Department of Digestive Surgery, Colorectal Surgery Unit, Toranomon Hospital Tokyo, Tokyo, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Tate
authors.affiliation: Department of Digestive Surgery, Colorectal Surgery Unit, Toranomon Hospital Tokyo, Tokyo, Japan.
authors.forename: Yudai
authors.initials: Y
authors.lastname: Fukui
authors.affiliation: Department of Digestive Surgery, Colorectal Surgery Unit, Toranomon Hospital Tokyo, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tomizawa
authors.affiliation: Department of Digestive Surgery, Colorectal Surgery Unit, Toranomon Hospital Tokyo, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hanaoka
authors.affiliation: Department of Digestive Surgery, Colorectal Surgery Unit, Toranomon Hospital Tokyo, Tokyo, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Moriyama
authors.affiliation: Department of Digestive Surgery, Colorectal Surgery Unit, Toranomon Hospital Tokyo, Tokyo, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Matoba
authors.affiliation: Department of Digestive Surgery, Colorectal Surgery Unit, Toranomon Hospital Tokyo, Tokyo, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kuroyanagi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000193:education* / Q000379:methods; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007564:Japan; D010535:Laparoscopy / Q000193:education*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: education; laparoscopic appendectomy; trainee