Single-incision laparoscopic appendectomy as a teaching procedure: A single-center experience with more than 200 procedures

Masaki Wakasugi, Mitsuyoshi Tei, Toru Masuzawa, Kenta Furukawa, Yozo Suzuki, Kentaro Kishi, Masahiro Tanemura, Hiroki Akamatsu. Osaka Police Hospital

Purpose: To evaluate resident performance and patient outcomes in patients undergoing single-incision laparoscopic appendectomy (SILA) by comparing resident-performed and staff doctor-performed procedures.

Methods: A retrospective analysis of 202 patients who underwent SILA from May 2009 to May 2015 at Osaka Police Hospital was performed. The residents in the study were distributed among all postgraduate years from three to five years. The staff surgeons in this study had advanced minimally invasive fellowship training and had routinely performed single-incision laparoscopic surgery. All operations performed by the residents were performed under the guidance of fully trained staff surgeons.

Results:  The residents operated on 77% (156/202) of patients undergoing SILA in our department. The mean age in the resident and staff surgeon groups was 38 years (range 6-84 years) and 49 years (range 8-89 years), respectively (p < 0.05). The patients operated by the staff surgeon had significantly higher rates of complicated appendicitis (61%, 28/46) than patients treated by the residents (40%, 62/156) (p < 0.05). There were no significant differences between the two groups with regard to the patients’ sex, BMI, and ASA. The mean operative time in the resident and staff surgeon groups was 76 min (range 26-243 min) and 111 min (range 32-240 min), respectively (p < 0.05). The mean bleeding volume in the resident and staff surgeon groups was 16 mL (range 0-800 mL) and 49 mL (range 0-400 mL), respectively (p < 0.05). The conversion rate to a different operative procedure was 3% (5/156) of the patients in the resident group and 13% (6/46) in the staff surgeon group, respectively (p < 0.05). Five cases in the resident group were converted: three to multi-port LA and two to open surgery. Six cases in the staff surgeon group were converted to multi-port LA. Perioperative complications were seen in 9% (14/156) of the patients in the resident group and 20% (9/46) of the patients in the staff surgeon group (p < 0.05). The mean postoperative hospital stay was 6 days (range 2-23 days) for the resident group and 8 days (range 2–23 days) for the staff surgeon group (p < 0.05).

Conclusions: SILA could be useful as a teaching procedure for the residents with adequate selection of patients and the guidance of a fully trained staff surgeon.


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