Asha Bale, MD, Lindsay Hallas, DO, Joshua R Klein, DO. Palisades Medical Center
Hospitals starting new surgical residency programs must accept higher operative times to support teaching in the operating room. Simulation labs are increasingly used by many training programs in order to improve resident laparoscopy skills. This study was done to determine the effect of resident participation on operative time for laparoscopic cholecystectomy and laparoscopic appendectomy, and examine if the availability of a laparoscopic simulation lab would improve resident operative time.
A new surgical residency program was started at Palisades Medical Center in 2012. We collected information on laparoscopic cholecystectomy and laparoscopic appendectomy performed from 2011- 2014 from the hospital operating room database. Operative time was recorded for three groups: July 2011- June 2012 when operations were performed by attending surgeons only (AS), July 2012- June 2013 when residents scrubbed with attendings (AR) and July 2013- June 2014, when simulation lab was introduced (ARS). Patient age, sex, ASA score and diagnosis were recorded. Data was analyzed using ANOVA.
In groups AS, AR and ARS there were 113, 155 and 161 laparoscopic cholecystectomies and 69, 63 and 81 laparoscopic appendectomies performed respectively. Operative time was significantly shorter in AS when compared to AR and ARS for both laparoscopic cholecystectomy (47 v 62 v 61 mins, p < .01) and for laparoscopic appendectomy (30 v 44 v 40 mins, p < .01). AR and ARS had similar operative time for both procedures. For laparoscopic cholecystectomy, operative time increased with increasing ASA score in all three groups. In all groups there was no significant difference in average age or sex.
Resident participation increases operative time for laparoscopic cholecystectomy and laparoscopic appendectomy in teaching hospitals. Increasing patient ASA score is associated with higher operative time. A simulation lab with no structured educational program does not appear to be sufficient in improving laparoscopic skills. This study suggests that implementation of a more formal curriculum in the laparoscopy simulation lab with attending supervision is necessary to improve skills learning in trainees.