Laparoscopic Appendectomy: a Junior Trainee's Learning Curve

BACKGROUND: Appendicectomy has traditionally been a training operation for junior surgical trainees. With the increased incidence of laparoscopic appendicectomy, concern has increased about the safety of this far more technically demanding procedure in the hands of junior surgical trainees. The learning curve of a junior surgeon is presented. METHODS: Consecutive patients having laparoscopic appendicectomy were studied. A 3-port Hasson technique was used. Patient demographics, conversion rate and reason for conversion, operation times, number of complicated cases (retrocecal position, dense adhesions, perforated/gangrenous/abscess associated appendicitis), and postoperative complications were recorded. The moving average and cumulative sum (CUSUM) methods were used to delineate the learning curve. RESULTS: Forty patients were studied. Median age was 24 (IQR: 18, 40). Twenty-nine (72.5%) patients were female. Data were not available for 3 patients (6%); the remaining patients form the basis of this study. A statistically significant improvement occurred in operating time between group 2 and group 3, P<0.0001 (95% CI, 21.23 to 47.99). The CUSUM plot demonstrates that the learning curve was surmounted by 20 cases performed. CONCLUSIONS: Laparoscopic appendicectomy is a safe procedure for junior trainees, and the learning curve stabilizes by 20 cases performed.