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Laparoscopic splenectomy does the training of minimally invasive surgical fellows affect outcomes?
D E Pace1, P M Chiasson, C M Schlachta
1The Centre for Minimally Invasive Surgery, St. Michael's Hospital, The University of Toronto, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8. eric.poulin@utoronto.ca
Background:
The training of surgeons and residents in laparoscopic surgery has become an important issue. The purpose of this study is to determine if the training of a laparoscopic fellow affects outcomes in patients undergoing laparoscopic splenectomy (LS).
Methods:
Data were obtained from a prospectively collected database of patients who underwent LS from August 1994 to November 1999. Outcomes of the last 25 cases, performed by fellows under supervision, were compared to 25 cases performed by staff surgeons prior to the introduction of fellows.
Results:
Patient demographics, preoperative platelet count, and splenic size were similar for the two groups. Outcome measures comparing the staff and the fellows group including operative time (151 vs 178 min, p = 0.055), blood loss (214 vs 162 ml, p = 0.40), intraoperative complications (3 vs 2, p = 1.0), need for transfusion (2 vs 3, p = 1.0), conversions (1 vs 0, p = 1.0), length of hospital stay (3.3 vs 2.5 days, p = 0.13), and postoperative complications (1 vs 2, p = 1.0) were similar for the two groups.
Conclusion:
When performed by a fellow under supervision, LS has the same outcomes as when the procedure is performed by the teaching staff surgeon.