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90th Annual Meeting Abstracts

The Impact of Laparoscopy on the Volume of Open Cases in General Surgery Training
*Fuad Alkhoury, MD, *Jeremiah T Martin, MD, *Jack Contessa, PHD, Steven Yood, MD, MPH, *Randall Zukerman, MD, *Geoffrey Nadzam, MD
Hospital of Saint Raphael, New Haven, CT

Objective: The purpose of this study was to evaluate the impact of laparoscopy on the volume of open cases in general surgery residency training over the past 10 years
Design: The ACGME database (1999-2008), which records all cases (by Current Procedural Terminology [CPT] code) performed by graduating general surgery trainees, was retrospectively analyzed
Setting: Accreditation Council for Graduate Medical Education (ACGME) database (1999-2008)
Main Outcome Measures: Trends were compared regarding the average number of the most common laparoscopic versus open procedures (colectomy, hernia and appendectomy) performed by graduating general surgery trainees over the reporting period
Results: Across all procedures, an increase was noted in laparoscopic approaches with a reciprocal decrease in open cases. The number of open appendectomies decreased by 29% (30.7 to 21.7), while the number of laparoscopic appendectomies increased by 278% (8.5 to 32.1). Similarly open inguinal hernia cases decreased by 12.5%(51.9 to 45.4) and open colectomy cases decreased by 10.4% (48 to 43). Conversely increases in laparoscopic hernia repair of 87.5% (8 to 15) and laparoscopic colectomy of 550% (2 to 13) were noted
Conclusions: In addition to the limitations placed upon residency training by other factors (including work hour restrictions), changing practice patterns within the field of general surgery have a significant impact on the exposure of residents to open surgery. This trend may have far-reaching implications with regard to overall competency of graduating residents and raises concerns for the future direction of surgical education


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