Cioffi Stefano Piero Bernardo, Altomare Michele, Borghi Alessandra, Spota Andrea, Bussa Martino, Ambrogi Federico, Granieri Stefano, Virdis Francesco, Cimbanassi Stefania
Department of Surgery, University of Rome Sapienza, Rome, Italy.
General Surgery - Trauma Team, Niguarda Hospital, Piazzale Dell'Ospedale Maggiore 3, 20162, Milan, Italy.
Updates Surg. 2025 May 16. doi: 10.1007/s13304-025-02224-y.
Introduction Laparoscopic Appendectomy (LA) allows residents to get early exposure to minimally invasive techniques. Despite its importance, involving residents as primary surgeons is a complex process, influenced by more than just clinical factors. Mentorship, environment, and perceptions play crucial roles. This study aimed to explore rates of residents' involvement in LA, the factors influencing the decision-making, and how surgeons and residents perceive the process. Methods We analyzed data from the REsiDENT-1 trial, covering 653 LA performed between 2019 and 2023 in 24 hospitals affiliated with the University of Milan. Adults with intraoperative acute appendicitis were included. Univariable analysis and multivariable logistic regression explored factors impacting residents' involvement and clinical outcomes. A survey captured the perspectives of surgeons and residents. Results Residents approached 35.9% of the procedures, with longer operative times 67.14 (± 28.1) vs 71.68 (± 24.44), p = 0.001. Trainees were more involved in academic hospitals and emergency surgery units and less complex cases with lower complication rates. Residents' involvement was hampered by patients' complexity in the multivariable analysis. Surgeons prioritized non-technical factors such as punctuality and reliability, whereas residents highlighted clinical complexity as a key consideration for the decision-making of the operator. Both groups agreed that structured feedback systems could improve the educational and training experiences. Conclusion LA remains a crucial procedure for surgical training, balancing hands-on learning with patient safety. Structured mentorship in academic and emergency settings could allow safe resident involvement. Future improvements should focus on clear feedback processes, better access to simulations, and standardized competency-based training to prepare residents for independent practice.
引言 腹腔镜阑尾切除术（LA）使住院医师能够尽早接触微创技术。尽管其很重要，但让住院医师作为主刀医生参与是一个复杂的过程，不仅受临床因素影响。导师指导、环境和认知也起着关键作用。本研究旨在探讨住院医师参与LA的比例、影响决策的因素，以及外科医生和住院医师对该过程的看法。方法 我们分析了来自REsiDENT-1试验的数据，该试验涵盖了2019年至2023年在米兰大学附属的24家医院进行的653例LA。纳入术中患有急性阑尾炎的成年人。单变量分析和多变量逻辑回归探讨了影响住院医师参与和临床结果的因素。一项调查收集了外科医生和住院医师的观点。结果 住院医师参与了35.9%的手术，手术时间更长，分别为67.14（±28.1）分钟和71.68（±24.44）分钟，p = 0.001。实习生在学术医院和急诊手术科室参与度更高，且参与的病例复杂性较低，并发症发生率也较低。在多变量分析中，患者病情的复杂性阻碍了住院医师的参与。外科医生将准时性和可靠性等非技术因素列为优先考虑因素，而住院医师则强调临床复杂性是术者决策的关键考虑因素。两组都认为结构化反馈系统可以改善教育和培训体验。结论 LA仍然是外科培训的关键手术，在实践学习与患者安全之间取得平衡。在学术和急诊环境中进行结构化的导师指导可以让住院医师安全地参与其中。未来的改进应侧重于明确的反馈流程、更好地获得模拟训练以及基于能力的标准化培训，以使住院医师为独立执业做好准备。
