[Introduction of laparoscopic colorectal surgery in the Sint Franciscus Gasthuis, Rotterdam, 2002/2005].
OBJECTIVE
Analysis of the introduction of laparoscopic colorectal surgery in practice


METHODS
Retrospective and descriptive.


METHODS
The introduction process of laparoscopic colorectal surgery in the Sint Franciscus Gasthuis (hospital) in Rotterdam, The Netherlands, was divided into 3 phases: the pioneers phase (1 August 2002 to 31 August 2004), the course phase (1 September 2004 to 31 December 2004) and the implementation phase (1 January 2005 to 31 August 2005). All patients who received elective laparoscopic colorectal resection (n = 88) of the total 255 patients who, according the current standard could be treated laparoscopically, were analysed for iatrogenic complications, operation time and the percentage that was performed by surgical residents.


RESULTS
The percentage of elective colorectal procedures that were performed laparoscopically increased significantly in the 3 phases from 17% (27/163), to 50% (18/36) and 77% (43/56). Of these procedures, 30% (8/27), 17% (3/18) and 16% (7/43) were converted to an open procedure respectively. During the pioneers phase, 5 iatrogenic complications occurred: 2 ureter stenoses, 1 colon lesion, 1 inferior mesenteric artery bleeding lesion and 1 renal vein bleeding resulting in secondary splenectomy. During the course and implementation phases, no iatrogenic complication lesion occurred. The average operation time decreased from 191 via 186 to 182 minutes, despite the fact that the percentage of procedures performed by surgical residents increased from 15% (4/27), to 22% (4/18) and to 44% (19/43) in the respective phases and despite the fact that the amount of rectum resections increased from 19% (5/27) via 44% (8/18) to 37% (16/43).


CONCLUSIONS
Specific training in laparoscopic colorectal surgery was combined with a safe and fast introduction of this technique in practice and the training program of surgical residents. This training could therefore avoid iatrogenic complication.
Aalbers
A G J
AG
Sint Franciscus Gasthuis, afd. Chirurgie, Postbus 10.900, 3004 BA Rotterdam.
Mannaerts
G H H
GH
D000368:Aged; D002983:Clinical Competence; D003108:Colonic Diseases / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome