Residency training in advanced laparoscopic surgery: how are we doing?

Despite the phenomenal growth of laparoscopic surgery since 1987, surgical residency training programs are failing to train residents in advanced laparoscopic procedures. Data were obtained from the operative registry maintained by the Department of General Surgery, Naval Medical Center San Diego and included all operations performed during the course of a 5-year general surgery residency by residents graduating in 1992 (group 1) and those graduating in 1996 (group 2). Each of the group 1 residents averaged 18 laparoscopic cholecystectomies and 68 open cholecystectomies, whereas the group 2 residents averaged 95 laparoscopic cholecystectomies and 18 open cholecystectomies. Group 1 residents averaged <1 advanced laparoscopic procedure during their residency, whereas group 2 residents averaged 46. Although there was no significant difference in total open cases between groups 1 and 2 (1,233 vs 1,197 respectively; p > 0.99), group 2 performed a significantly greater proportion of laparoscopic cases (12% vs 1%; p < 0.001). The teaching of advanced laparoscopic procedures can and should be incorporated into the surgical residency.