Laparoscopic appendectomy as an index procedure for surgical trainees: clinical outcomes and learning curve

Ussia, Alessandro; Vaccari, Samuele; Gallo, Gaetano; Grossi, Ugo; Ussia, Riccardo; Sartarelli, L; Minghetti, Margherita; Lauro, Augusto; Barbieri, Paolo Nicola; Saverio, Salomone Di; Cervellera, Maurizio; Tonini, Valeria

doi:10.1007/s13304-020-00950-z

Cited by 17 publications

(13 citation statements)

References 42 publications

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“…In our research, there was a considerable increase in the amount of time spent on patients treated with LA. This has been documented in several earlier investigations, such as Taguchi et al (15) Blood loss was much reduced in the LA group in our investigation, which is consistent with Shimoda et al (16) results. Another difficulty in the comparison of LA and OA is the longer operational duration and substantial blood loss during LA.…”

Section: Discussionsupporting

confidence: 94%

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Study of Heel Pain in Rheumatic Diseases

Mohamed

Thabet²

2022

The Egyptian Journal of Hospital Medicine

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Background: Laparoscopic appendectomy has mostly replaced open surgery. Appendectomy, or surgical removal of the appendix, is one of the most common operations performed by a specialized surgeon and is used to teach the fundamentals of laparoscopy -first by observing and then performing the procedure independently. Aim of the work: This study compared laparoscopic and open surgery for suspected appendicitis. Methods: A total of 200 individuals with probable appendicitis participated in this prospective randomized clinical study. All patients over the age of 18 who had a clinical diagnosis of appendicitis were randomly randomized to either open appendectomy (OA) or laparoscopic appendectomy (LA). First prophylactic antimicrobial treatment was administered intravenously. Supine posture and general anesthesia were provided to all patients. After the operation, we followed up for complications and survival. Results: The operating time in laparoscopic patients was significantly greater. However, blood loss was substantially lower. The need for analgesics was substantially reduced in the laparoscopic group. There was a substantial difference between included patients in both groups in terms of postoperative stay length, time to return to work/normal activities, and the incidence of postoperative complications. In terms of survival time or complication incidence, there was no significant difference between the two groups. Conclusion: Despite the longer operational time, LA has a favorable hands-on OA in terms of blood loss, length of postoperative stay, time to return to work/normal activities, and the incidence of postoperative problems. In terms of survival time and complication incidence, there was no significant difference.

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Section: Discussionsupporting

confidence: 94%

“…Taguchi et al (15) found no statistically significant difference between OA and LA in terms of post-operative hospital stay or liquids and solids resumption. Older research (19) found a substantial difference between the OA and LA groups when it came to resuming normal activities.…”

Section: Discussionmentioning

confidence: 94%

Study of Heel Pain in Rheumatic Diseases

Mohamed

Thabet²

2022

The Egyptian Journal of Hospital Medicine

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“…Napjainkra a laparoszkópos appendectomia már hazánkban is a gyermeksebész-rezidensek tanuló-, gyakorlóműtétje lett, a betanulási fázis eredményeinek köszönhetően [7,16]. Ennek a minimálisan invazív műtétnek a bevezetése során intézetünkben komoly ellenállást tapasztaltunk a műtői szakdolgozók részéről, mert az eljárást kezdetben hosszabbnak találták.…”

Section: Eredeti Közleményunclassified

“…A gyermeksebész-gyakornokok képzése során a minimálisan invazív "tanulóműtétek" egyike a laparoszkópos appendectomia. A technika az irodalom alapján gyorsan és könnyen elsajátítható, illetve -a tapasztaltabb kollégák eredményeivel összehasonlítva -a szövődmények sem magasabbak [7].…”

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Laparoszkópos appendectomia gyermekkorban.

Fadgyas

Garai

Ringwald

et al. 2022

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Bevezetés: A laparoszkópos appendectomiának a gyermekek esetében is számos előnye lehet a nyílt műtéttel szemben. Célkitűzés: A szerzők vizsgálni kívánták, hogy a nyílt műtétről a laparoszkópos appendectomiára történő áttérés hozott-e változást a műtéti idő, a kórházi ápolási idő és szövődmények tekintetében. Módszerek: A retrospektív, megfigyelésen alapuló vizsgálatba a 2016 és 2017 között akut appendectomián átesett, 0–18 éves betegek kerültek bevonásra. Kizárási kritérium volt az egyidejűleg történő egyéb műtét és/vagy a diagnosztikát befolyásoló társbetegség (például malignitás, Meckel-diverticulum, ovarialis folyamat), valamint a laparoszkópiával indított, de nyílt műtétbe történő konverzió. A betegeket nyílt és laparoszkópos appendectomiás csoportokba osztották. A szerzők a műtéti időtartamot, a kórházi tartózkodás idejét és a posztoperatív szövődményeket hasonlították össze. A statisztikai analízishez a Mann–Whitney-tesztet, a Fisher-féle egzakt és khi-négyzet-teszteket alkalmazták. Eredmények: A vizsgált időszakban 297 appendectomia történt (nyílt : laparoszkópos = 149 : 148). A laparoszkópos eljárás műtéti ideje a „betanulási fázis” végére (2017) számottevően rövidebbnek bizonyult a nyílttal szemben (p = 0,0003). A kórházi tartózkodás rövidebbnek bizonyult laparoszkópia után (p<0,0001). Szövődmény kialakulásában nem volt különbség a nyílt és a laparoszkópos csoport (p = 0,2409) között. Megbeszélés: Tanulmányunk támogatja azon angol nyelvű nemzetközi tanulmányokat, melyek alapján egy laparoszkóppal, gyermekkorban is elvégezhető műtét eredményei a „betanulási fázist” követően nem különböznek, adott esetben jobbak, a nyílt műtét eredményeihez képest. Következtetés: A laparoszkópos appendectomia gyermekkorban is biztonságosan elvégezhető műtét. A laparoszkópos technikára a korábban csak nyílt műtétet végzett gyermeksebészek is át tudnak állni rövid tanulási időszak után. Orv Hetil. 2022; 163(25): 1001–1004.

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“…A number of previous studies (8-10) have been conducted on smaller cohorts of patients and surgeons under training, showing that operation times decrease, reaching a plateau after around 20-30 procedures (11). A recent study on a larger cohort of 1173 patients undergoing laparoscopic appendectomy showed that there was no signi cant difference between surgical trainees and senior colleagues regarding operation time, length of stay, and complications (12). However, we do not know whether these studies are valid in the Swedish setting.…”

Section: Introductionmentioning

confidence: 99%

Learning curve of trainees performing laparoscopic appendectomy- a register-based study

Young

Boström

Sandblom

et al. 2021

Preprint

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Background Appendectomy is one of the first procedures that surgical trainees are expected to manage alone. The purpose of this study was to analyse the learning curve of a cohort of surgical trainees and to explore the association between trainee surgeon volume and complication rate. Method The study was based on a cohort extracted from the local appendectomy register at Södersjukhuset (transl. South Hospital), Stockholm. The register includes patient characteristics, surgical method, operation time, and 30-day complications. First-year surgical trainees attending the hospital’s trainee programme were included and followed over five years of training. Trainees who had performed less than ten procedures during the period of the study were excluded. The learning curve was described using moving average of order ten for each trainee, studying the trend in operation time with increasing volume. The cumulative sum technique was used to chart changes in complication rates of the trainees. Results 586 procedures performed by 9 surgical trainees were included, of which 97.6% were performed laparoscopically. A plateau in operation time on the learning curve was reached at 60 procedures. For three of the trainees, the 30-day complication rate decreased after completing the learning curve, whereas for two others it increased. In a multivariate analysis, operation times differed more between the trainees than it did between procedures performed early or late in the programme. Shortest versus longest mean operation time (41 min versus 89 min). Conclusion At least 60 procedures are required to reach sufficient proficiency in appendectomy. This highlights the importance of meticulous selection of surgical trainees, structure of training programmes, feedback, and assessment.

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Laparoscopic appendectomy as an index procedure for surgical trainees: clinical outcomes and learning curve

Cited by 17 publications

References 42 publications

Study of Heel Pain in Rheumatic Diseases

Study of Heel Pain in Rheumatic Diseases

Laparoszkópos appendectomia gyermekkorban.

Learning curve of trainees performing laparoscopic appendectomy- a register-based study

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