THE INTEGRATION OF LAPAROSCOPY INTO A SURGICAL RESIDENCY AND IMPLICATIONS FOR THE TRAINING ENVIRONMENT

Although laparoscopic cholecystectomy is now an accepted part of resid ent training, the impact of operative laparoscopy (OL) upon the reside ncy environment has not been examined in detail. We reviewed the first 3 years' experience with OL and the process by which it was introduce d into our residency program. Data were obtained from our prospective computerized surgical laparoscopic registry as well as from a survey c onducted midway in this experience. At that time, a questionnaire was sent to current residents in the program and residents who graduated a fter the inception of the OL program were interviewed by telephone. OL cases increased each year and comprised a progressively greater perce ntage of total cases. Residents performed over 97% of cases, with atte nding surgeons as first assistants. Initially, only senior-level resid ents participated as surgeons; however, after the first year we noted a significant tendency for cases to filter down the ranks. Junior-leve l residents have already participated in more laparoscopic than open c holecystectomies and expressed considerable concern about training in open procedures. Graduated residents without exception were able to ob tain privileges to perform OL without additional training. They did no t feel that resident education was compromised by the advent of laparo scopy. Both current and graduated residents considered didactic sessio ns including animal laboratories and simulators an important part of t raining. With appropriate use of didactic sessions, simulators, and an imal laboratories, a radically new procedure (OL) can be successfully introduced into a surgical residency program and subsequently taught t hrough conventional means.