The surgical outcomes and educational value of three laparoscopic approaches for pediatric appendectomy performed by surgical residents rotating through pediatric surgery and pediatric surgery fellow training programs: a two-institution retrospective study.

PURPOSE: Laparoscopic appendectomy (LA) is the ideal initial laparoscopic procedure for surgical residents, but the comparative educational value of conventional three-port LA (CTPLA), transumbilical laparoscopy-assisted appendectomy (TULAA), and two-site LA (TSLA) remains unclear.

METHODS

We retrospectively analyzed 372 pediatric patients who underwent LA at two institutions between 2016 and 2024. The cases were stratified by technique and appendicitis severity (simple, n = 217; complicated, n = 155). The physicians were classified into the junior residents/surgical residents' group (JR/SR group; n = 55) or the pediatric surgery fellow group (PSF group; n = 317).

RESULTS

In simple appendicitis, TULAA demonstrated a shorter operative time (62.0 min) than TSLA (85.0 min; p < 0.001) and a shorter pneumoperitoneum time than both other approaches (p < 0.001). Similar advantages were observed in patients with complicated appendicitis. The postoperative hospital stay was shorter with TULAA and CTPLA than with TSLA in simple appendicitis (4.0 vs. 5.0days; p < 0.001). The perioperative complication rates were comparable. TULAA operative time was significantly influenced by surgeon experience (JR/SR group: 94.0 vs. PSF group: 59.5 min; p = 0.005), whereas TSLA was experience-independent (p = 0.983).

CONCLUSION

TULAA offers optimal operative efficiency for early resident training. The sequential progression from TULAA to CTPLA to TSLA provides a data-driven framework for structured laparoscopic training in pediatric surgery.