Related Experiment Video
Updated: Jan 29, 2026
Principles of Rodent Surgery for the New Surgeon
Published on: January 6, 2011
The Pediatric Surgical Team: a Model for Increased Surgeon Index Case Exposure
Sidney M Johnson1, William G Lee1, Devin P Puapong1
1Kapi'olani Medical Center for Children, 1319 Punahou St., Honolulu, HI, USA 96826.
Insights
A surgical team approach in complex pediatric surgery helps maintain surgeon case volumes, especially in isolated areas. This model supports competence and workforce allocation in pediatric surgical care.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Healthcare Systems
Background:
- National trends show decreasing pediatric surgeon case volumes for complex procedures.
- High surgical volume is generally linked to better patient outcomes.
- Geographically isolated settings face unique challenges in maintaining surgical expertise.
Purpose of the Study:
- To evaluate the impact of a surgical team approach on pediatric surgeon exposure to complex cases.
- To assess the feasibility of this model in a geographically isolated setting.
- To compare in-house surgeon experience with national benchmarks.
Main Methods:
- Implemented a surgical team approach (co-surgeons/assistant surgeons) for complex pediatric cases starting in 2010.
- Reviewed institutional data on surgeon index case volumes.
- Compared experienced volumes against published national median volumes for pediatric surgeons.
Main Results:
- The surgical team approach was utilized in the majority of complex cases, including tracheoesophageal fistula, biliary atresia, and pediatric oncology.
- Surgeon index case exposure exceeded national medians for most complex pediatric surgical procedures studied.
- An exception was noted for splenic operations compared to published national experience.
Conclusions:
- A collaborative surgical team model can help maintain adequate index case volumes for pediatric surgeons.
- This approach is beneficial for sustaining surgical competence in isolated practices and low-volume hospitals.
- The model offers valuable insights for pediatric surgical systems development and workforce planning.
Background/Purpose:
High surgical volume for both surgeons and hospital systems has been linked to improved outcomes for many surgical problems, yet case volumes per pediatric surgeon are diminishing nationally in complex pediatric surgery. We therefore sought to review our experience in a geographically isolated setting where a surgical team approach has been used to improve per-surgeon exposure to index pediatric surgical cases.
Methods:
As a surgical group, we incorporated a surgical team approach to complex pediatric surgical cases in 2010. We obtained institutional review board approval to review our pediatric surgeon index case volume experience. We then compared our surgeon experience to published surgical volumes for complex pediatric surgical cases.
Results:
A surgical team approach (2 or 3 board certified pediatric surgeons/urologists working as co-surgeons or assistant surgeon) was used in the majority of cases for tracheoesophageal fistula/esophageal atresia (77%), congenital pulmonary airway malformation (73.5%), cloaca (75%), anorectal malformation (43.6%) biliary atresia (77.8%), Hirschsprung's disease (51.9%), congenital diaphragmatic hernia (67.6%), robotic choledochal cyst (100%), and complex oncology (adrenal tumors, neuroblastoma, Wilms tumor and Hepatoblastoma surgery) (85-100%). Over the 5-year period, surgeon index case exposure for all index pediatric surgical cases was above the published national median for pediatric surgeons, except for in splenic operations when contrasted to published experience.
Conclusions:
A surgical team approach to complex pediatric surgery may help maintain exposure to adequate index case volumes. This model may be useful for maintaining competence in geographically-isolated practice settings and low-volume pediatric hospitals that provide surgical care; the model has implications for systems development and workforce allocation within pediatric surgery.
Level Of Evidence:
4.
Related Concept Videos
01:18Increasing Function
01:21Interdisciplinary Care: The Health Care Team-I
Physicians
The physician's primary responsibility is to diagnose illness and direct the medical or surgical treatment of the condition. The authority to admit patients to a healthcare agency or institution and practice care within that setting is granted to physicians by the healthcare agency or institution...
01:18Interdisciplinary Care: The Health Care Team-II
Physical Therapist
A physical therapist (PT) aims to restore function or prevent additional impairment in a patient following an injury or disease. Massage, heat, cold, water, sonar waves, exercises, and electrical stimulation are some treatments used by PTs to treat...
01:25Increased Body Temperature
01:17Increased pulse rate
Many factors can elevate the risk of developing tachycardia. These include advanced age, a family history of arrhythmias, and an...
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion