Katherine Bingmer, MD, Asya Ofshteyn, MD, Sharon L Stein, MD, Emily Steinhagen, MD. University Hospitals Cleveland Medical Center
Introduction: Advances in the field of minimally invasive surgery have reduced the incidence of traditional open techniques. As the volume of laparoscopic cases increase, general surgery residents may have reduced opportunity to perform open surgical procedures. While a significant amount of attention has been given to the decline of open techniques in training of vascular surgery residents, minimal data is available on the decline of open procedures in general surgery residency other than cholecystectomy and appendectomy. We aimed to investigate if this trend can be seen in other commonly performed procedures.
Methods and Procedures: The Accreditation Council for Graduate Medical Education resident case log statistical reports from years 2000-2016 were analyzed for trends in the number of cases performed by graduating general surgery residents in the United States. General surgery cases that are frequently performed using both laparoscopic and open techniques were selected for analysis: anti-reflux surgery, appendectomy, colectomy, splenectomy, and inguinal hernia repair. Linear regression was performed to evaluate change over time.
Results: The average number of cases in five categories performed by graduating residents increased from 163 in 2000 to 215 in 2016 (32%). The average number of laparoscopic cases increased from 28 to 127 (354%), whereas the number of open cases decreased from 135 to 89 (34%), depicted in Figure 1. An increase in the number of laparoscopic cases was seen in all five procedures: anti-reflux 6.2 to 8 (29%), appendectomy 10.4 to 59 (467%), colectomy 2.2 to 23.9 (986%), splenectomy 1 to 1.2 (20%), and inguinal hernia 8 to 34.3 (329%). This corresponded to a decrease in the amount of open procedures performed: anti-reflux 4 to 0.6 (85%), appendectomy 31 to 6.3 (80%), colectomy 45.8 to 33 (27%), splenectomy 3.2 to 1.3 (59%), inguinal hernia 51 to 47.3 (7%).
Conclusion: As the number of laparoscopic procedures increases, there has been an accompanying decrease in general surgery resident exposure to the traditional open approaches. Some procedures, such as appendectomy and colectomy, have experienced a sharper decline than others. Further investigation will determine the impact of declining open surgery volume on resident skill acquisition, and the best methods of effectively teaching open surgery in the setting of increased laparoscopic surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93352
Program Number: S014
Presentation Session: Education
Presentation Type: Podium