Implications of laparoscopy on surgery residency training

BACKGROUND: With the advent of laparoscopy, many traditional junior-level cases now require advanced laparoscopic skill. We Sought to ascertain the implications of laparoscopy on residency training through the use of a large national database. METHODS: American College Of Surgeons National Surgical Quality Improvement Program data were gathered for patients undergoing elective open and laparoscopic inguinal herniorrhaphy, appendectomy, and partial colectomy during 2005 and 2006. Cases were stratified, by resident level and compared using univariate analysis. RESULTS: A total of 14,729 cases were performed during the study period. For inguinal hernia repair, 72% of open repairs were performed by postgraduate year 3 residents or below versus 41% of laparoscopic repairs (P<.0001). Similarly, 61% of open appendectomies were performed by postgraduate year 3 residents or below compared with 48% of laparoscopic appendectomies (P<.0001). Forty-six percent of open colectomies were performed by postgraduate year 3 and postgraduate year 4 residents versus 33% of laparoscopic resections (P<.0001). CONCLUSIONS: These data show an upward shift in cases traditionally performed by junior-level residents. The implications of this shift are unknown but may lead to decreased surgical experience during the early years of training, (C) 2009 Elsevier Inc. All rights reserved.