Seasoned surgeons assessed in a laparoscopic surgical crisis.

OBJECTIVE: Maintenance of certification is a relatively new concept in the United States, and there is no mandatory retirement for surgeons. Our aim was to compare technical and team performance of surgeons of different ages in a simulated laparoscopic surgical crisis and validate a potential recredentialing tool for surgeons.
METHODS: Using a single-blinded protocol, the performance of six "Seasoned" surgeons >55 years (mean 64, range 55-83) was compared to six "control" surgeons <55 years (mean 46, range 34-53) in a simulation. Surgical teams established pneumoperitoneum, trocar access, and managed intraabdominal hemorrhage in a simulated laparoscopic cholecystectomy while videotaped as part of an IRB protocol. Surgeons' performance was scored using validated technical and team performance scales.
RESULTS: All of the "seasoned" surgeons relegated the use of unfamiliar technology to their assistants. All control surgeons achieved intraabdominal pneumoperitoneum themselves. Mean blood loss for seasoned surgeons and control surgeons was 2,555 versus 2,725 ml (NS), respectively. After recognition of bleeding in the unstable patient, senior surgeons converted to an urgent laparotomy case after 2.4 vs. 3.3 min for control group (NS). No difference was observed in overall technical and team abilities (p = NS). On debriefing, 85% of surgeons recommended simulation for training and recertification.
CONCLUSIONS: Seasoned surgeons can use their assistant surgeon well to assure a safe and effective operation. Mandatory operating room retirement based on age may be arbitrary and should be replaced by performance measures. Simulation may prove a valuable tool for self -assessment and recredentialing.