50 Cases of Laparoscopic Appendectomy by One Surgical Resident: The Learning Curve and Safety

Song, Hyun Seok; Jung, Ki Hoon; Ha, Dong Yeop; Jung, Byung Ook; Jung, Ho Geun; Lee, Kwan

Abstract

PURPOSE
The frequency of performing laparoscopic appendectomy (LA) has increased compared to that of open appendectomy because of its advantages such as decreased postoperative pain, shorter hospitalization and quicker recovery. The advantages of minimally invasive surgery are well known to the general public, so we recognized the importance of a laparoscopic training course. We analyzed the results of LA performed by one resident and we determined the learning curve and the safety.
METHODS
We retrospectively studied 50 consecutive patients with a preoperative diagnosis of acute appendectomy and who underwent LA by one surgical resident. We used the medical and video records and compared the patients' age, gender, BMI, the location of the appendix tip, the pathologic findings, the state of drainage insertion, intraoperative bleeding, conversion to open surgery, the operation time and the complicating factor affecting the operating time.
RESULTS
The mean operation time was 79.9 minutes and the operation time was effectively shortened when the surgeon had many experiences, the patients had a low BMI and there was no perforation, periappendiceal abscess or insertion of drains. After 25 cases of surgery experience (LA), the surgeon had enough expertise for the operations. Two cases of wound infection around the umbilical area and 1 case of intraperitoneal fluid collection occurred after the surgery. Yet this was all soon cured by wound dressing and the use of antibiotics.
CONCLUSION
Fifty cases of LA were safely performed by one surgical resident. Thus, LA is a suitable procedure for surgical residents and it helpful for learning the basic technique of other advanced laparoscopic surgeries.