The Effect of Minimally-invasive Surgery Fellowships on General Surgery Resident Case Volume
Chaibutr K, MD1, Srijaroenwanit C, MD1, Subwongcharoen S, MD1
Affiliation : 1 Department of Surgery, Rajavithi Hospital College of Medicine, Rangsit University, Bangkok, Thailand
Background : Laparoscopic surgery has become the standard treatment for many diseases, and some complex operations are now
using this technique. Minimally-invasive surgery (MIS) fellowship training was developed to improve the safety of the patients and
develop the modality of laparoscopic surgery in Thailand; however, there has been some debate regarding its effect on general
surgical resident training.
Objectives: The aim of this study was to test the hypothesis that the presence of the MIS fellowship has had no adverse effect on chief
resident laparoscopic case volume.
Materials and Methods : The operative case logs of graduating residents and fellows from 2008 to 2014 were reviewed, focusing on
both basic and complex laparoscopic cases and comparing those 2 groups in terms of number of performing surgeons and assistant
surgeons.
Results : The number of residents graduating from June 2008 to May 2014 (6 to 11 residents per year) was 53 (31 before and 22 after
the establishment of the MIS fellowship program). A significant increase was observed in the number of total laparoscopic cases
performed by chief residents (13.74 before and 25.86 cases after, p<0.001). There was no significant difference in the average
number of cases performed by the residents in either basic or complex laparoscopic procedures (0.61 vs. 1.50, p = 0.124 and 0.06
vs. 0.05, p = 0.769) before and after the MIS fellowships program, but the average assistant cases increased in both basic and
complex laparoscopic procedures (7.55 vs. 14.18, p = 0.001 and 5.52 vs. 10.14, p = 0.001). Over the same period, our fellows (2
fellows per year) performed an average of 50 cases per year, most of which were complex laparoscopic cases.
Conclusion : Minimally-invasive surgery fellowships have had no adverse effect on the basic or complex laparoscopic case experience
of general surgical residents. There was an increase in the number of cases involving participation of residents after the MIS
program. The MIS fellowships and general surgical residency can coexist successfully.
Keywords : Minimally-invasive fellowship program, Resident training
