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Utilizing a 3D Printed Laparoscopic Nissen Fundoplication Model to Shorten a Resident's Learning Curve
Published on: August 15, 2025
Outcomes for trainees vs experienced surgeons undertaking laparoscopic antireflux surgery - is equipoise achieved?
Claire N Brown1, Lorelle T Smith, David I Watson
1Department of Surgery and the Royal Adelaide Hospital, University of Adelaide, Level 5, Eleanor Harrald Building, Royal Adelaide Hospital, 5000 Adelaide, South Australia, Australia. clrnbrown@doctors.org.uk
Summary
Supervised laparoscopic fundoplication by trainees showed slightly worse outcomes than experienced surgeons, impacting patient satisfaction and re-operation rates. Even with supervision, a learning curve persists in antireflux surgery.
Area of Science:
- Gastrointestinal Surgery
- Surgical Education
- Patient Outcomes Research
Background:
- Laparoscopic antireflux surgery has a learning curve affecting patient outcomes.
- Supervision by experienced surgeons may mitigate this learning curve.
- The impact of supervised training on laparoscopic fundoplication outcomes requires evaluation.
Purpose of the Study:
- To assess the effect of surgeon supervision on laparoscopic fundoplication outcomes.
- To compare patient results between experienced consultants and supervised trainees.
- To investigate the influence of large hiatus hernias on outcomes in supervised training.
Main Methods:
- Prospective database analysis of 1,710 patients undergoing laparoscopic antireflux surgery (1995-2009).
- Classification of patients based on surgeon experience (consultant vs. supervised trainee).
- Standardized questionnaires assessed heartburn, dysphagia, and satisfaction at 1 and 5 years.
Main Results:
- No difference in peri-operative complications between trainees and consultants.
- Trainee-operated patients had higher rates of endoscopic dilatation (9% vs 5%) and re-operation (9% vs 6%).
- Lower patient satisfaction (76% vs 82%) was observed in the trainee group within 5 years.
Conclusions:
- A statistically significant, though small, learning curve effect was observed in laparoscopic fundoplication.
- Supervised trainees had slightly lesser outcomes compared to experienced consultants.
- Findings raise ethical considerations regarding surgical training and patient safety.
