Longer operative times but equally safe - a propensity score-matched analysis for laparoscopic procedures in women with early-stage (r-ASRM I-II) endometriosis performed by gynecology residents compared to attending surgeons

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INTRODUCTION: Surgery for endometriosis is usually performed through minimally invasive surgery, either by experienced endometriosis surgeons or by supervised gynecology residents during their surgical training. This trial aimed to assess the influence of surgical experience on the efficiency and safety of minimally invasive surgery treatment for early-stage endometriosis. MATERIAL AND METHODS: Post- and introperative complications rates and length of stay of patients with stage I and II (revised American Society of Reproductive Medicine stage (rASRM)) endometriosis undergoing laparoscopic surgery at the University Hospital Mainz, Germany, between 2018 and 2022 were evaluated in a propensity score-matched analysis based on the experience of the primary surgeon (resident/fellow vs. attending). Linear and logistic regression models were used on the matched data set to calculate the treatment effect on the treated. RESULTS: 580 patients were included in the final data set. Of those, 339 were operated on by 11 attending surgeons and 241 by 22 residents/fellows. The matched dataset showed a mean difference of 0.02 in propensity scores after full propensity score-matching. Compared to surgical procedures performed by experienced surgeons, prolonged operating times were found for surgeries performed by residents/fellows (5.27 min in the whole data set (SE 1.36), p < 0.001), and 9.54 min (SE 3.57, p = 0.007) when analyzing only rASRM stage II endometriosis. The need for revision surgery was reduced in the resident/fellow group, but did not reach statistical significance (0.56 (95%CI: 0.301-0.1.02), p = 0.06). No significant differences were found for intra- or postoperative complications and length of hospital stay. CONCLUSIONS: Gynecology residents and fellows trained on the patient can safely perform surgery for early-stage endometriosis at the cost of increased operative times. Additional training options, such as surgical simulation training, should be explored to shorten learning curves, reduce the financial burden on hospitals due to prolonged operative times and counter the impending reduction in intraoperative training possibilities for residents.

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