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OBJECTIVE: From tabloids to scientific journals, many articles describe the relative danger of receiving medical care during the early months of the academic year. This is due to the influx of new trainees as they progress up the professional ladder in their medical education and take on more complex duties, some for the first time. The aim of this study was to examine the outcomes and efficiency of an advanced laparoscopic procedure performed in a Minimally Invasive Surgery fellowship and to determine if any real differences existed between the early training months and the later training months.METHODS: For this study, data was retrospectively analyzed from an IRB approved database consisting of laparoscopic Heller myotomies completed in a MIS program from 1999 to 2009. Patient demographics (age, ASA, BMI) and outcome variables including operating room (OR) time, transfusion requirements, complications, and hospital length of stay were reviewed. There were no deaths. Cases performed between the first (July through September) and last (March through May) months of fellowship training were compared. Standard statistical analysis was performed with a p value of <0.05 considered significant.RESULTS: Our data included 54 laparoscopic Heller myotomies (30 in early training and 24 in late training). Pre-operative parameters such as age, ASA, and BMI were statistically similar between patients undergoing surgery early in fellowship training and those who received care late in training (Table 1). Outcomes such as operative time, length of stay, transfusions received, and complications were also similar between the early and late cohorts of patients (Table 2). CONCLUSIONS: Performance of advanced laparoscopic procedures in a Minimally Invasive Surgery program is safe regardless of whether the surgery is performed early or late in fellowship training. Despite the intricate skill set required for laparoscopic Heller myotomy, attending mentorship and fundamental skills from residency likely contribute to the lack of increased morbidity or mortality in early fellowship training.
Table 1. Pre-Operative Characteristics

	Early (n = 30)	Late (n = 24)	p-value
Age (yrs)	47.63	45.83	0.6743
ASA	2.11	2.14	0.9013
BMI (m/kg2)	25.58	29.10	0.1181

Table 2. Outcomes

	Early (n = 30)	Late (n = 24)	p-value
LOS (days)	3.13	2.13	0.9050
OR time (min)	175.61	202.70	0.2443
Transfusions (PRBCs)	0.00	0.00	1.000
Complications	0.20	0.08	0.5439