Getting residents in the game: an evaluation of general surgery residents' participation in pediatric laparoscopic surgery.

PURPOSE

In a large children's hospital, the authors evaluated general surgery residents' experience with pediatric laparoscopic procedures and the impact of their participation on patient outcome.

METHODS

The records of all children who underwent laparoscopic appendectomy, splenectomy, fundoplication, or pyloromyotomy were reviewed. The level of participation by general surgery residents in each of these operations was determined. Outcome was assessed for these procedures in terms of intraoperative and postoperative complications.

RESULTS

A resident was the operating surgeon in 164 of 174 laparoscopic appendectomies (94%), 37 of 38 laparoscopic splenectomies (97%), 78 of 104 laparoscopic fundoplications (75%), and 72 of 97 laparoscopic pyloromyotomies (74%). Adverse outcomes in the cases in which a resident was surgeon were limited to 4 postappendectomy infectious complications, 3 cases of recurrent reflux after fundoplication, and one incomplete myotomy and one mucosal injury after laparoscopic pyloromyotomy.

CONCLUSIONS

The authors have shown that well-supervised general surgery residents can perform common, pediatric laparoscopic operations with excellent results. Although it is essential for established pediatric surgeons and fellows in pediatric surgery to acquire expertise in minimally invasive surgery, once they have confidence in their own skills they may safely permit qualified general surgery residents to perform laparoscopic procedures in children.