Assessing retroperitoneal lymphadenectomy experience in United States urological residency programs

Surgical experience is important for the mastery of operative procedures. We evaluated the current United States urological surgical resident training in performing retroperitoneal lymph node dissection.

The Accreditation Council for Graduate Medical Education Residency Review Committee for Urology operative log reports from 2000 through 2004 were reviewed. We analyzed resident retroperitoneal lymph node dissection experience as surgeon and first assistant by examining CPT codes for retroperitoneal lymph node dissection (CPT codes 38780, 38570 and 38572).

The overall number of retroperitoneal lymph node dissections performed at urological residency training programs has increased from 2000 to 2004 (781 to 924). The average number of retroperitoneal lymph node dissections performed by graduating residents in 2001 and 2004 did not change significantly (3.5 vs 4.0). Half of all graduating urology residents in 2004 had performed 2 or fewer retroperitoneal lymph node dissections as the primary surgeon and 1 or none as the first assistant during their training program. However, a small percentage (10%) of graduating residents completed their respective programs with 9 or more retroperitoneal lymph node dissections as primary surgeon and 4 as first assistant. There were no laparoscopic retroperitoneal lymph node dissections logged by graduating residents from 2001 through 2004.

Accreditation Council for Graduate Medical Education data suggest that many urology residents have minimal surgical exposure and training in retroperitoneal lymphadenectomy. These results indicate that alternative strategies should be explored not only to improve the residency training experience but also to determine minimum training criteria.