Training period in laparoscopic colorectal surgery.
BACKGROUND
Thorough training is essential to the success of colorectal laparoscopic surgery (LPS). The aim of this study was to evaluate the results of a 3-month training period in LPS.


METHODS
Before beginning the study, the surgical team attended several courses of LPS and spent a long time working at a large animal facility to perfect laparoscopic techniques. Twenty-six consecutive patients underwent LPS in a 3-month training period. Controls (n = 26) who underwent open colorectal surgery (LPT) were selected to match the LPS patients for age, gender, primary disease, type of surgery, comorbidity, and nutritional status.


RESULTS
Conversion to open surgery was necessary in one patient (3.8%). The operative time was 1 h longer for LPS than LPT (p < 0.001). The mean number of lymph nodes harvested was 17 in LPS and 18 in LPT (p = 0.76). The first flatus (p < 0.02) and bowel movement (p < 0.002) occurred earlier in the LPS group. The postoperative infection rate was 11.5% for LPS and 19.2% for LPT (p = 0.33). Two anastomotic leaks occurred in each group. The mean postoperative hospital stay was 9.6 days (standard deviation [SD], 2.6) for LPS and 11.0 days (SD, 5.2) for LPT (p = 0.68). Recovery of postoperative physical performance and social life occurred earlier in the LPS than the LPT group (p < 0.001). At 1-year follow-up, no difference was found in terms of cancer recurrence or long-term complications.


CONCLUSIONS
Oncologic results and postoperative morbidity were comparable for LPS and LPT. LPS allows a faster postoperative recovery.
Braga
M
M
Department of Surgery, San Raffaele University, Via Olgettina 60, 20132 Milan, Italy. braga.marco@hsr.it
Vignali
A
A
Zuliani
W
W
Radaelli
G
G
Gianotti
L
L
Toussoun
G
G
Carlo
V
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003107:Colorectal Surgery / Q000193:education* / Q000379:methods*; D004239:Diverticulitis, Colonic / Q000601:surgery; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality