S. B. Cairo1, C. M. Harmon1,2, D. H. Rothstein1,2 1Women And Children’s Hospital Of Buffalo,Department Of Pediatric Surgery,Buffalo, NY, USA 2State University Of New York, University At Buffalo,Department Of Surgery,Buffalo, NY, USA
Introduction: Minimally invasive pediatric surgery has increased in breadth and complexity over the past several decades, but little is known about the penetration of minimally invasive surgery (MIS) training in U.S. and Canadian pediatric surgery fellowship programs.
Methods: We performed a time series analysis of Accreditation Council for Graduate Medical Education (ACGME) pediatric surgery fellow case logs from 2004 to 2016. Procedures were included if they had both open and MIS options. Proportions of cases performed in an MIS fashion as well as per-fellow MIS case averages were recorded over time.
Results: There was a 30.9% increase in average number of cases reported per fellow over the study time period. Twenty-three procedures included MIS and open options (17 abdominal, 3 thoracic, and 3 genitourinary procedures). The proportion of cases performed using a minimally invasive approach increased by an average of 29.0%, 14.6%, and 47.0% for abdominal, thoracic, and genitourinary operations, respectively. Significant variability was observed between individual fellows in all categories as demonstrated by reported laparoscopic and open inguinal hernias ranging from 0 to 85 and 9 to 152 per trainee, respectively, in the final year of data collection (Table 1). When examining a high volume procedure with a substantial increase in application of MIS, such as pyloromotomy, an overall increase in the proportion of cases performed MIS vs open of 83.3% was observed. The minimum and maximum number of cases recorded ranged from 0 to 114 during the eight years in which minimally invasive pyloromyotomy was recorded.
Conclusion: Minimally invasive surgery case exposure among graduating U.S. and Canadian pediatric survey fellows increased substantially during the study period, although data on cases of particular interest, such as repair of tracheoesophageal fistula and congenital diaphragmatic hernia, are not captured. More data from surgical case logs, national databases, graduating fellows, and fellowship directors are needed to better define the current operative experience and criteria for determination of competency in advanced MIS.
