The Northeastern Society of Plastic Surgeons

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Early Laparoscopic Experience of New Pediatric Urology Attendings
Kristina D. Suson, MD1, Cortney Wolfe-Christensen, PhD2, Jack S. Elder, MD3, Yegappan Lakshmanan, MD1.
1Children's Hospital of Michigan, Detroit, MI, USA, 2Cook Children's, Fort Worth, TX, USA, 3MassGeneral Hospital for Children, Boston, MA, USA.

BACKGROUND: Minimally invasive surgery has increasingly become the standard approach for adult urology, even among urologists in their first two years of practice. We questioned if that was also true of recent pediatric urology fellowship graduates.
METHODS: Case logs of urologists applying for oral boards who self-identified as pediatric urologists were examined. To be included, the urologist must have performed ≥75% of the cases on patients aged 0-21 years and submitted a log of 6 months. The cases ranged from a start date of 7/30/07 to an end date of 6/30/13. Laparoscopic cases for each applicant were collated, and compared when appropriate to matching open cases. Data points included case, dates of case submission, and age, gender and geographic data of surgeon.
RESULTS: The case log of 72 pediatric urologists were included for analysis. Their mean age was 36.40.3 (32.5-45.6) years. A total of 412 laparoscopic procedures was performed. Surgeons performed a mean 5.70.6 (0-27, median 4) laparoscopic cases. Males, comprising 60.6% of urologists, performed more laparoscopic cases than females (mean 6.81.0 vs 4.10.6, p=0.035). The number of laparoscopic cases increased significantly over the course of the series (r(71)=.39, p=0.001). Surgeons performing above the median number of laparoscopic cases were younger than those below the median (35.80.4 vs 37.00.4 years, p=0.044). While there was not a significant relationship between the number of laparoscopic cases and the total number of cases performed (p=0.23), cases more likely to be performed laparoscopically included nephrectomy (p=0.012) and orchiopexy for abdominal testis (p<0.001). Cases more likely to be performed open included hernia repair (p<0.001) and ureteral reimplantation (p<0.001). Cases for which there was no significant difference included partial nephrectomy (p=0.162), pyeloplasty (p=0.534) and varicocelectomy (p=0.216). There were no differences in the number of laparoscopic procedures performed based on the region (p=0.37), practice area (p=0.67), or practice type (p=0.17).
CONCLUSIONS: Pediatric urologists graduating 10 years ago performed less laparoscopy immediately upon fellowship graduation than recent grads. Male pediatric urologists performed more laparoscopy than female surgeons. While laparoscopy was the approach of choice for nephrectomy and abdominal orchiopexy, the open approach was preferred or similar for most procedures, indicating that current training offers both traditional and minimally invasive experiences.


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