The need for training opportunities in advanced laparoscopic surgery - Theresidents' perspective

Background: There is controversy regarding the amount of training necessary to safely perform advanced laparoscopic surgery. General surgical residenc y often provides only a low volume of advanced laparoscopic cases and there is growing interest in nonaccredited fellowships focused on laparoscopic s urgery. Objective: To assess surgical residents' perception of the need for trainin g in advanced laparoscopic surgery in addition to that provided in a standa rd general surgical residency. Methods: A 15-item questionnaire was mailed to 985 physicians who either we re Society of American Gastrointestinal Endoscopic Surgeons (SAGES) candida te members or had attended a SAGES resident course in 1998 or 1999. For the purposes of the survey, laparoscopic Nissen fundoplication, laparoscopic h erniorrhaphy, laparoscopic splenectomy, and laparoscopic colectomy were cho sen as advanced procedures. Results: Of the 85 responses obtained, 81% were from respondents who were a t the postgraduate fourth-year (PG4) level or higher. Furthermore, 58% of t he respondents had taken a course in advanced laparoscopic surgery outside their residency program. The respondents believed that to perform the proce dures safely and with confidence on entering practice, they needed to do at least eight each of the selected laparoscopic procedures. As reported, 45% of the respondents had performed three or fewer laparoscopic hernias; 60% had performed three or fewer laparoscopic Nissen fundoplications; 81% had p erformed three or fewer laparoscopic colectomies; and 86% had performed thr ee or fewer splenectomies. Only 32% of the residents expected to perform mo re than 10 laparoscopic Nissen fundoplications, only 10% expected to perfor m more than 10 colectomies, and only 4% expected to perform more than 10 sp lenectomies before completing their residency. Many respondents (65%) said they would pursue an additional year of advanced laparoscopic training if i t were available. In programs unaffiliated with a fellowship in advanced la paroscopic surgery, 65% of the residents were concerned that such a fellows hip would interfere with residency training in laparoscopic surgery. In com parison, only 24% of the residents in programs affiliated with a fellowship in advanced laparoscopic surgery believed that the fellowship interfered w ith their training, whereas 47% of the residents in programs affiliated wit h a fellowship in advanced laparoscopic surgery thought that the fellowship had no impact on their training Conclusions: Residents clearly perceive a need for additional training in a dvanced laparoscopic surgery. Residents from programs without a laparoscopi c fellowship are concerned about a negative impact on their experience from a laparoscopic fellow, but residents from programs with a laparoscopic fel lowship are neutral about the impact of a fellow.