Feasibility of safe laparoscopic surgery performed by junior residents without exposure of open appendectomy: A retrospective study.

Abstract

Appendectomy is the most commonly performed surgery in the emergency department. It is very difficult to determine the minimal duration of the learning curve for junior residents to perform safe laparoscopic surgeries. This study aimed to determine the feasibility of a safe laparoscopic appendectomy performed by junior residents. A retrospective study was conducted at a tertiary healthcare center from May 2018 to May 2020. This study reviewed all the data of laparoscopic appendectomy performed by junior and senior residents. Both groups were compared for the patient outcome in terms of complications, conversion to open, intraoperative findings, operative time, postoperative progress, and hospital stay. The data were formulated in an excel sheet and analyzed with SPSS. Mean, median, range, standard deviation, percentages, univariate analysis with χ test and <i>t-</i>test were used. No significant difference was found in operative time (mean [SD], 84.87 [24.73] vs. 86.95 [24.93], <i>P</i> = 0.679), intraoperative complication (9.2% vs. 7.8%, <i>P</i> = 0.769), postoperative complications (34.2% vs. 34.4%, <i>P</i> = 0.984), conversion to open (6.6% vs. 4.7%, <i>P</i> = 0.633), length of postoperative hospital stay (Mean [SD], 2.3 [2] vs. 2.2 [1], <i>P</i> = 0.739), and readmission (4% vs. 3%, <i>P</i> = 0.794). No major intraoperative complications and mortality were found in both groups. Junior residents may be allowed for safe laparoscopic appendectomy under supervision without experience of open appendectomy. The patient's outcomes may be comparable with surgery performed by well-experienced surgeons. They can improve the basic healthcare system in the future with feasible basic laparoscopic surgery for common diseases.