Resident Learning Curve for Laparoscopic Appendectomy According to Seniority

Abstract

<jats:p>Purpose: This study sought to delineate the learning curve (LC) for laparoscopic appendectomy (LA) in surgical residency according to seniority and experience.Methods: Between October 2015 and November 2016, 150 patients underwent LA performed by one of 3 residents (who were in their first [A], second [B], or third [C] year of training) under supervision. The patients were nonrandomly assigned to each resident. Data from a prospectively collected database were reviewed and analyzed retrospectively. Perioperative outcomes including operation time, complications, and conversion were compared among the 3 residents. The LC was evaluated using the moving average method and cumulative sum control chart (CUSUM) for operation time and surgical completion.Results: Baseline characteristics and perioperative outcomes were similar among the 3 groups except for age and location of the appendix. The operation time did not vary among the 3 residents (43.9, 45.3, and 48.4 minutes for A, B, and C, respectively; P=0.392). The moving average method for operation time showed a decreasing tendency for all residents. CUSUM results for operation time revealed peak points achieved at the 24th, 18th, and 31st cases for residents A, B, and C, respectively. In terms of surgical failure, residents A, B, and C reached steady states after their 35th, 11th, and 16th cases, respectively. Perforation of the appendix base was the only risk factor for surgical failure.Conclusion: The resident LC for LA was 11 to 35 cases according to multidimensional statistical analyses. The accumulation of surgical experience among residents might influence the LC for surgical completion but not that for operation time.</jats:p>

Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

“…Great heterogeneity in the learning curve assessment was noted; six studies described the chronological distribution in groups and their evaluation [ 21 – 26 ]; one study used the moving average method [ 27 ]; two studies used the cumulative sum (CUSUM) analysis [ 20 , 28 ]; two studies adopted both the moving average method and the CUSUM analysis [ 29 , 30 ]; and two studies applied the procedural-based assessment [ 31 , 32 ]. Moreover, six studies evaluated the learning process of resident surgeons [ 21 , 27 , 29 – 32 ], four of graduated surgeons [ 20 , 22 , 23 , 28 ], and three involved both residents and consultants [ 24 – 26 ].…”

“…In 2020, Kim et al [ 30 ] published an analysis of 150 laparoscopic appendectomies performed by residents with a growing level of seniority and experience. Three residents, at the first, second or third year of training, performed 50 consecutive laparoscopic appendectomies; no significant differences were shown in operating time (OT) between the three operating residents.…”

Clinical outcomes of locking polymeric clip for laparoscopic appendectomy in patients with appendicitis: a retrospective comparison with loop ligature

“…The possible reasons for this finding are as follows. (1) Trainees participate in surgery for education, which is reported to be associated with a longer operative time [16][17][18]. (2) Our institution is a cancer-specific hospital that performs fewer than 30 cases of LA annually.…”

Disposable free three port laparoscopic appendectomy – low cost alternative for emergency

“…27,28 Safety is an important aspect to consider in surgery as common as appendectomy, where even the number of procedures performed by each surgeon has implications in increasing complications, length of hospital stay, and cost of the procedure. 27,29 In contrast, if performed safely and using a noninvasive method in a specialized environment, discharge rates can be achieved in less than a day in up to 90% of cases. 6,30 The technique described in this study, with three portals -one umbilical and two supra-pubic -has an extremely satisfactory aesthetic result, because the scars remain hidden behind the underwear when the abdominal wall is exposed.…”