Abstracts
1999 Digestive Disease Week

# 2091 LAPAROSCOPIC GI SURGERY: THE COST OF RESIDENT TRAINING.
C. Daniel Smith, Timothy M. Farrell, John G. Hunter, Emory Univ Sch of Medicine, Atlanta, GA

Introduction: The mandate to contain costs while optimizing patient outcome demands assessment of the expense of teaching laparoscopy to residents. Therefore, we measured additional costs incurred during common laparoscopic procedures when the staff surgeon assumed a teaching role.
Methods: Prospective data collected over 10-months by two academic GI surgeons were stratified according to the role of the surgeon. Laparoscopic cholecystectomy (L-CHOLE) and fundoplication (L-FUNDO) were selected to represent basic and advanced procedures. Operative times were compared for cases in which the staff surgeon functioned as operating surgeon versus teaching assistant (T-test). The expense of teaching laparoscopy in the operating room was calculated based on /min of OR time.
Results: When the staff surgeon functioned as teaching assistant rather than operating surgeon, the mean OR time was extended by 20 min for L-CHOLE (p=NS) and 30 min for L-FUNDO (p<0.001) (TABLE).
Conclusions: Clearly, there is added expense in teaching laparoscopy in the OR. Teaching advanced procedures significantly increases the cost of an operation, even at an institution where these advanced procedures are "routine". This added cost may prohibit intraoperative teaching of advanced laparoscopy, except for those residents demonstrating exceptional technical skill and interest.

TABLE. Mean OR Time (+/- SD) Based on Role of the Staff Surgeon
Staff as Operating Surgeon			Staff as Teaching Assistant
Case	#	Operative Time	#	Operative Time	*P-Value	Additional Cost (0
L-CHOLE	27	83.3 +/- 50.0	23	103.9 +/- 48.1	NS	329.60
L-FUNDO	77	131.5 +/- 45.6	54	164.4 +/- 49/8	<0.001	526.40
*T-test

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