Gas off, room lights on: Shedding light on the surgical resident's experience in open and laparoscopic surgery

Abstract

Background: The operative experience of today's surgery residents is different than years past. Although overall volume remains stable, the composition is changing. As such, trends in open versus laparoscopic surgery for general surgery residents were examined.

Methods: The Accreditation Council for Graduate Medical Education national operative log reports from 1994 to 2018 were analyzed for the 15 operations recorded as both open and laparoscopic. Operative volume was examined for total major, surgeon chief, and surgeon junior cases.

Results: From 1994 to 2018, 26,258 residents graduated with 955.2 ± 31.7 total major cases. The 15 identified operations comprised 38.4% of this volume. During the 25-year study period, laparoscopic volume increased (+9.67 cases per year), whereas open volume decreased (-3.25 cases per year, P < .0001 for each). Similar trends were seen for both chief and surgeon junior cases (P < .05 for both). For 2 of the 4 core general surgery operations examined (hernia and proctocolectomy), the open approach was still the dominant approach, providing residents an opportunity to perform open surgery in an era of increasing minimally invasive approaches.

Conclusion: For select procedures, the frequency of laparoscopy has surpassed open surgery for general surgery residents. These trends raise the concern that when necessary, general surgery graduates may not have adequate experience converting to open.