Laparoscopic Appendectomy: Is There a Learning Curve after Completion of Colorectal Fellowships Training?

Purpose: Recent studies have shown that the procedure of laparoscopic appendectomy requires a learning curve before mastering. The aim of this study was to investigate the question of whether a surgeon who has been working as a first assistant for training in laparoscopic colorectal surgery can perform laparoscopic appendectomy without previous experience as an operator in laparoscopic appendectomy. Methods: Ninety consecutive patients who underwent laparoscopic appendectomy by a single surgeon were retrospectively enrolled in this study. The operating surgeon completed fellowship training of the colorectal cancer division as a first assistant for two years. The patients were divided into two groups by consecutive order: Group (A) included the initial 45 patients and Group (B) included the next 45 patients. The clinical patient demographics, histological diagnosis, and outcome variables including operation time, conversion to open surgery, complications, and length of hospital stay were compared between the two groups. Results: No difference in operation time was observed between the groups (mean: 58.22 min vs 66.6 min, p=0.097). Open conversion rate and drain insertion rate were similar between the two groups. There was no difference in length of hospital stay. Overall complication rate did not differ between the two groups. Moving average curve showed no specific time shortening point within these 90 enrolled patients. Conclusion: This study demonstrates that laparoscopic appendectomies performed by a surgeon who had achieved a training course as an assistant in laparoscopic colorectal surgery were performed safely without any difficulties during the learning period. This finding needs further validation in additional large-scale studies.