Decreasing Trend of Open Surgical Experience- A Drawback for Surgery Residents

Abstract

Introduction: The first minimally invasive surgery (MIS) was attempted by Georg Kelling in 1901. However, we had to wait for the development of the computer chip television in the late 1980s to make the first successful laparoscopic cholecystectomy. The laparoscopic cholecystectomy rapidly grew in popularity but there were many questions about its safety compared with the “gold standard” of open cholecystectomy. The same pictures were seen in other general surgery procedures including appendectomy, colectomy, and herniorrhaphy. With additional experience, training, and improvement of surgical instruments, the early “learning curve” injuries were decreased.
Materials and methods: A Prospective studywas conducted at Department of General Surgery, Shivamogga Institute of Medical Sciences, Shimoga from January 2022-December 2024. Based on questionnaire method for all the General surgery residents performing both open and Laparoscopic surgeries. 40 collective feedbacks were obtained and were subjected for data analysis. A retrospective review of the questionnaire based on post graduates done at Department of General Surgery, Shivamogga Institute of Medical Sciences, Shimoga was performed. The retrospective review was based on the medical research department (MRD) -resident case log statistical reports from academic years 2016–2022. This study is based on publicly available data and therefore was exempted from institutional review board approval. Cases were chosen for analysis based on availability of both open and laparoscopic data, and to encompass a broad scope of general surgery: anti-reflux surgery, appendectomy, colectomy, splenectomy, and inguinal hernia repair. These case logs were evaluated for trends in the number of cases performed by General Surgery residents at Department of General Surgery, Shivamogga Institute of Medical Sciences, Shimoga.
Results: The average number of cases in five categories performed by graduating residents increased from 254 in 2016 to 278 in 2022 (8.6%). The average number of laparoscopic cases increased from 58 to 128 (54.6%), whereas the number of open cases decreased from 196 to 150 (30.6%), depicted in Figure 1. An increase in the number of laparoscopic cases was seen in all five procedures: anti-reflux 6.2 to 8 (22.5%), appendectomy 18 to 28 (35.7%), colectomy 4 to 7 (42.8%), splenectomy 1 to 1.2 (20%), and hernia repairs 29 to 84 (65.4%). This corresponded to a decrease in the amount of open procedures performed: anti- reflux 4 to 0.8 (80%), appendectomy 31 to 11 (64.5%), colectomy 45.8 to 33 (27%), splenectomy 3.2 to 1.3 (59%), all hernias 51 to 47.3 (7%).
Conclusion: The number of open procedures performed by general surgery residents continues to decline despite an increase in total cases reported. However the advent or the practice of basic and laparoscopic procedures aren’t disregarded as they are the future of surgical practices but the reduction in open surgical experience may result in surgeons lacking technical skills to safely and competently perform open procedures. Therefore, a shift in the educational paradigm can produce competent, confident, surgeons and will be worth the effort.