Does Surgical Teaching Take Time? Resident Participation in Minimally Invasive Hysterectomy for Endometrial Cancer.
To determine the association between resident involvement and operative time for minimally invasive surgery (MIS) for endometrial cancer.



A retrospective cohort study (Canadian Task Force classification II-2).



An integrated health care system in Northern California.



A total of 1433 women who underwent MIS for endometrial cancer and endometrial intraepithelial neoplasia from January 2009 to January 2014.



Resident participation in 430 of 688 laparoscopic cases (62%) and 341 of 745 robotic cases (46%).



The primary outcome was the impact of resident involvement on surgical time. When residents were involved in laparoscopic and robotic surgery, there was an increase of 61 minutes (median operative time, 186 vs 125 minutes; p < .001) and 31 minutes (median operative time, 165 vs 134 minutes; p < .001), respectively. Resident participation was associated with increased operative times in all levels of surgical complexity from hysterectomy alone to hysterectomy with pelvic and para-aortic lymph node dissection. Resident participation was also associated with increased major intraoperative complications (3.4% vs 1.8%, p = .02) as well as major postoperative complications (6.4% vs 3.8%, p = .003).



The presence of a resident was associated with a 32% increase in operative time for minimally invasive cases in gynecologic oncology for endometrial cancer. Because of the retrospective nature, we cannot infer causality of operative outcomes because residents were also involved in more high-risk patients and complex cases. For health care systems using surgical metrics, there may be a need to allocate more time for resident involvement.
Kaiser Permanente San Francisco, Department of Obstetrics and Gynecology, San Francisco, California.
Alexandra H
AH
Freeman
Rebecca and John Moores UCSD Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, La Jolla, California.
Allison
A
Barrie
Kaiser Permanente Northern California, Division of Research, Oakland, California.
Liisa
L
Lyon
Kaiser Permanente Northern California, Division of Research, Oakland, California.
Carol
C
Conell
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia, Charlottesville, Virginia.
Christine
C
Garcia
Kaiser Permanente Northern California Gynecologic Cancer Program, San Francisco, California.
Ramey D
RD
Littell
Kaiser Permanente Northern California, Division of Research, Oakland, California; Kaiser Permanente Northern California Gynecologic Cancer Program, San Francisco, California. Electronic address: Bethan.Powell@kp.org.
C Bethan
CB
Powell
D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000193:education* / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000706:statistics & numerical data*; D010535:Laparoscopy / Q000009:adverse effects / Q000193:education / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000193:education* / Q000706:statistics & numerical data; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000193:education* / Q000706:statistics & numerical data; D013337:Students, Medical / Q000706:statistics & numerical data; D013997:Time Factors; D014594:Uterine Neoplasms / Q000601:surgery; D000074824:Work Engagement
Minimally invasive surgery; Resident involvement