Evolution of minimally invasive techniques within an academic surgical practice at a single institution

We aimed to understand how changes in surgical techniques are transferred into surgical practice. We hypothesized that the integration of minimally invasive surgery (MIS) techniques into a pediatric surgical practice is dependent on the hiring of junior partners who can transfer their MIS knowledge to senior surgeons.

We reviewed the operative approach to six different general pediatric surgical procedures from 2000 to 2012, including appendectomy, fundoplication, gastrostomy tube placement, pyloromyotomy, colectomy, and lobectomy (lung). The percentage of MIS cases was calculated for each procedure annually. Each year six to nine fellowship-trained pediatric surgeons operated at our institution. Three surgeons completed training in the era of MIS (hired in 2001, 2007, and 2009) and remained on staff for at least 3 years.

In 2000, 49% of procedures were performed with MIS. This increased to 98% in 2013 (P<.0001). Appendectomy, pyloromyotomy, and fundoplication demonstrated early adoption and uniform use of laparoscopy (>85%) by 2007. Gastrostomy tube placement reached 90% laparoscopy utilization in 2009. Lobectomy (lung) and colectomy also reached >80% MIS use in 2009 and 2010, respectively. The same trends were seen when looking only at senior surgeons who completed training prior to 2000.

The hiring of junior surgeons with MIS training was associated with an increase in adoption of MIS techniques by the entire group. Procedures that were introduced early in the MIS era demonstrated a gradual rise toward uniform adoption of MIS techniques. More advanced and recently adopted MIS techniques demonstrated a rapid rise to uniform adoption.