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.