Shift to Minimally Invasive Techniques Impairs Surgeon’s Skills

While minimally invasive surgery (MIS) has made procedures easier and recovery time faster, it has resulted in surgical residents that lack certain operative skills, according to a new study.

Researchers at the University of Texas (UT) Health Science Center (UTHSCSA; San Antonio, USA) conducted a study to assess the overall impact of laparoscopy on their surgical residency training program by analyzing data from all patients who underwent a cholecystectomy procedure at UTHSCSA over three decades: 1981-1990, which they called the pre-laparoscopic era; 1991-2001, the first decade of laparoscopic cholecystectomy; and 2004-2013, the most recent decade of laparoscopic cholecystectomy.

The results showed that the average number of open cholecystectomies performed per graduating chief general surgery resident dramatically decreased for both laparoscopic decades, compared with the pre- laparoscopic decade. If in the pre-laparoscopic era the average general surgery resident performed 90 open cholecystectomies, by 2000 they performed 15.5; this figure decreased to 12.6 by 2004. This represents a 67% reduction during the first decade of laparoscopic cholecystectomy, and 92% for the most recent decade. The study was published in the April 2016 issue of the Journal of the American College of Surgeon.

“Our residents are getting a minimum amount of exposure to the open procedure, so we are concerned about whether they will have enough technical experience to do an open cholecystectomy,” said lead author professor Kenneth Sirinek, MD, PhD. “In particular, we are concerned about surgeons who have to convert from laparoscopy to the open procedure during an operation. This is problematic because they will not have enough know-how to take on a very complicated patient with severe inflammation secondary to acute/gangrenous cholecystitis.”

To make up for this technical deficit, the authors offer several recommendations, such as participation in a fellowship program with senior surgeon mentoring, which would allow them to practice and perfect the technical skills needed to perform complicated open and laparoscopic biliary cases. In addition, each general surgery residency program should build a video library of complicated open biliary procedures; residents could thus discuss instructional presentations with faculty surgeons for additional technical input. Simulation models could also be used to help train novice learners in critical surgical techniques.

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