Laparoscopic pyloromyotomy can be performed safely by senior pediatric surgery trainees without supervision at high volume centers
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Topic overview
Abstract
Aim of the Study
Pediatric surgery trainees at our institution perform 15 to 20 supervised laparoscopic pyloromyotomies during their junior year, and are allowed to perform the operation independently without supervision during their senior year. We reviewed the outcomes of laparoscopic pyloromyotomies performed by senior trainees operating without supervision and compared them to experienced pediatric surgeons.
Method
We did a retrospective reviewed of all unsupervised laparoscopic pyloromyotomies (n = 90) performed by the last 12 pediatric surgery fellows (2012–2018) during their senior year, and the most recent 90 consecutive laparoscopic pyloromyotomies performed by 9 experienced pediatric surgeons. Statistical significance was determined by T-test and Fisher's exact test. Data is expressed as mean (SD) or median (range). A p value of ≤0.05 was considered significant.
Results
Mean age at surgery was 4.7 (SD: 1.6) and 5 (SD: 2.3) weeks in the trainees and surgeons group, respectively (p = 0.38). Mean operative time was 28 (SD: 13) minutes in the trainees group vs. 25 (SD: 10) minutes in the surgeons group (p = 0.09). Intraoperative complications occurred in 3 of 90 (2.7%) cases in the trainees group (three mucosal perforations, all detected during the operation, one repaired laparoscopically, two repaired open), and none in the surgeons group (p = 0.11). One postoperative complication requiring reoperation occurred in the trainees group (omentum eviscerated through an incision site), while none occurred in the surgeons group (p = 0.36). No incomplete pyloromyotomies occurred in either group. The median length of postoperative hospital stay was 1 (1 to 10) and 1 (1 to 6) days in the trainees and surgeons group, respectively (p = 0.63).
Conclusion
Senior trainees at high-volume training programs can perform unsupervised laparoscopic pyloromyotomies safely as a mean to promote surgical autonomy without compromising patient outcomes.
Level of Evidence
III
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