Hands-On Training of Surgical Trainees Has No Significant Impact on Surgical Quality Parameters of Kidney Transplant Procedures (2012)

Introduction: A structured surgical training program is needed to recruit young surgeons to the field of transplantation. Theoretical knowledge, tactical considerations and manual skills are key to successfully perform complex operative procedures. Until recently, surgical training in Germany was a byproduct on the surgical service of academic hospitals rather than a major focus. Regarding the imminent lack of young surgical residents, a structured program is needed to recruit last year medical students to this field. We hypothesize that within a dedicated training program, operative procedures performed by the trainee under the guidance of a senior surgeon are equally safe and not significantly different in terms of objective quality markers such as operative times, complication rates and markers of early outcome. Here we report our experience in implementing this new training culture on the basis of 108 consecutively performed deceased donor kidney transplant procedures. Methods: To assess the impact of surgical training on surgical quality we have retrospectively analyzed 108 kidney transplant procedures from deceased donors performed between 1/2010 to 7/2011. Transplant procedures were analyzed in three groups: 1) cases performed by the senior surgeon a senior-resident or junior surgeon being the 1st assistant (NO-TRAINING), 2) training cases performed by a senior resident or junior surgeon under supervision (TRAINING), and 3) cases performed by the senior surgeon with a junior resident with a surgical skills set considered to be too low to be trained on the case, while there was no trainable senior resident/junior surgeon available (NO AVAILABILITY). Surrogate markers of surgical quality were analyzed for each group. There were no statistical significant differences in operating time, hospital stay, 3-months renal function, the number of reoperations and the complication rate between the groups. Results: In total 108 kidney transplant procedures from deceased donors were analyzed. Whenever possible the procedure was assisted to a more junior surgeon. 37% of the cases were performed by the Training group, 32% by the no-training group and 30% by the No-availability group. Training experience was primarily provided by the consultants and the fellow, while more junior surgeons had the tendency to perform the case themselves. There was no statistical difference in the distribution of assistant and primary surgeon role between day, evening and nighttime transplants. The postoperative time in hospital was similar in all groups. The additional time spent for a trainee to assist in the procedure was a median of 10 minutes, not significantly different. Renal function determined by S- creatinine was similar at 3 months after transplantation. Also the postoperative complications were not statistically significant between the groups. Conclusion: Under the guidance of an experienced transplant surgeon hands-on training is equally safe and should be encouraged to maintain transplant surgery as an attractive option for young surgeons in Germany.