Aim of the Study: Pediatric surgery trainees at our program are allowed to perform unsupervised laparoscopic appendectomies during their last year of training to promote independent patient management and operative decision-making skills. In this study we reviewed the outcomes of laparoscopic appendectomies done by senior trainees without supervision and compared them to the outcomes of experience pediatric surgeons.
Methods: We reviewed 500 laparoscopic appendectomies performed without supervision by the last 10 consecutive senior pediatric surgery trainees (first 50 cases of each trainee); 2011-2017. We compared those outcomes with the last 200 laparoscopic appendectomies performed by eight experienced pediatric surgeons (last 25 of each surgeon). Primary outcomes: operative time, intraoperative and postoperative complications, length of stay, re-admissions, re-operations.
Main Results: Median age in the “trainees” and the “surgeons” groups was 11 (2 - 22) and 12 (2 - 20) years (p: 0.351). The proportion of perforated appendicitis was 98/500 (19.6%) and 42/200 (21%) in the trainees and surgeons groups, respectively (p: 0.753). Mean operative time was 41 (SD 14.5) minutes in the trainees group vs. 39 (SD 16.1) minutes in the surgeons group (p: 0.052). Minor intraoperative complications occurred in 3/500 cases in the trainees group vs. 1/200 in the surgeons group (p: 0.691). There were no major complications in either group. Postoperative abscesses requiring percutaneous intervention developed in 6/500 and 5/200 cases in the trainees and surgeons groups, respectively (p: 0.36). Mean (SD) length of stay was 2.05 (2.4) and 2.3 (2.9) in the trainees and surgeons groups, respectively (p: 0.253). There were 13/500 vs. 5/200 readmissions (p: 0.92), and 1/500 vs. 1/200 reoperations in the trainees and surgeons groups, respectively (p: 0.91).
Conclusion: Allowing senior pediatric surgery trainees to perform laparoscopic appendectomies without supervision is a safe way to stimulate confidence and autonomy without compromising patient quality of care.