Jonas Raakow, Hans-Georg Liesaus and Roland Raakow
Background: Single-incision laparoscopic appendectomy (SILA) has become an accepted alternative to conventional multiport laparoscopic appendectomy. Yet, little is known about the impact of operations performed by residents on the outcome of SILA. The aim of the present study was to evaluate the safety and efficacy of SILA performed by younger surgeons.
Methods: All SILA's at a single institution were reviewed and grouped according to the educational level of the operating surgeon: group 1 included residents with no experience in single-incision laparoscopic surgery (SILS) and little experience in multiport laparoscopy, group 2 comprised fellows with experience in multiport laparoscopy but with no experience in SILS, and group 3 consisted of senior surgeons, all of whom were experienced in performing SILS.
Results: A total of 176 patients were included. The patients had been operated on by residents (n=62), fellows (n=21), or senior surgeons (n=93). Senior surgeons performed the operation in less time than fellows or residents (48.7 vs. 55.4 vs. 53.6 minutes, respectively; p=0.108). Six patients required conversion to multiport laparoscopy while no patient required conversion to the open procedure. The overall postoperative morbidity was 9.1%, with no significant difference between the three groups (p=0.536). The surgeon's level of surgical education was no statistical risk factor for developing postoperative complications after SILA.
Conclusion: Although operating times were longer for residents and fellows compared to senior surgeons, less surgical experience did not correlate with a greater need for conversion to multiport laparoscopy and was not associated with a higher rate of postoperative complications.
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