MP47: Surgical Technology & Simulation: Training & Skills Assessment II
MP47-20: Trends in Open and Minimally Invasive Case Logs and Comfort Level Among US Urology Residents
Friday, May 15, 2020
7:00 AM – 9:00 AM
Molly DeWitt-Foy, Robert Abouassaly, Eric Klein, Georges-Pascal Haber, Elyse Custodio, Moben Mirza, Kristen Scarpato, Daniel Williams, IV, Harcharan Gill, Andrew Peterson, Derenda Gold, Debra DeConick, Denise Mussehl, Rustin Massoudi, Steven Campbell
Introduction: Urologists' use of minimally invasive surgery (MIS) has increased rapidly in the last decade. In reaction this, the Urology RRC set required minimums of MIS cases for residents to complete prior to graduation. No such guidelines exist for open surgery, though the ability to perform these procedures open remains essential for occasional situations where conversion to open is necessary. In this descriptive study we evaluate the change in proportion of MIS and open oncologic cases logged by graduating US urology residents, along with the relative comfort level of graduating residents in performing these surgeries.
Methods: Combined ACGME case logs were queried for common urologic oncologic cases logged by residents graduating in 2006-2017 from five academic institutions. Logs were searched for radical prostatectomy (RPx), radical and partial nephrectomy (PNx), and radical cystectomy, and were characterized as open or MIS. In addition, surveys regarding the relative comfort level of performing RPx and PNx, open vs MIS, were sent to 24 graduating or recently graduated residents from five institutions. Descriptive statistics were employed to characterize rate of change.
Results: From 2006-2017 the percentage of open cases downtrended significantly by an average of -2.9% per year or 57 fewer open oncologic cases per graduate over the course of training. This represented a change from 77.6% to 38.9% open cases over this timeframe. Among 16 residents who returned completed surveys 81.25% (13/16) felt more comfortable doing a robotic in lieu of open RPx, 2 felt equally comfortable with either approach, and only one felt more comfortable performing an open RPx. Half of respondents felt more comfortable doing a robotic PNx, 25% felt equally comfortable using either approach, and 25% felt more comfortable performing an open PNx.
Conclusions: In the last decade the proportion of open urologic oncology procedures has declined, and graduating residents now feel more comfortable performing these procedures robotically than they do open. We anticipate the number of open cases will continue to decrease as the remaining attendings who perform a significant number of open cases retire. Given this context, it may be worthwhile for the Urology RRC to consider establishing minimum case numbers for principal open urologic oncology procedures. Source of