Early introduction of laparoscopic sigmoid colectomy during residency.
BACKGROUND
Laparoscopic sigmoid colectomy for benign diseases is becoming the standard of care. However, few residency programmes incorporate the procedure. This study evaluated the safety and feasibility of the early introduction of laparoscopic sigmoid colectomy during residency.


METHODS
From a database of consecutive laparoscopic sigmoid colectomies collected prospectively over 6 years, those for cancer and primary open sigmoid colectomies were excluded. Surgeons were categorized into five levels of experience in colonic surgery. Patient demographics, operative data, complications and conversion rates were assessed.


RESULTS
A total of 262 sigmoid colectomies were performed by 13 surgeons. American Society of Anesthesiologists grade and diverticular disease classification were similar across the five experience levels. There were no significant differences in morbidity, mortality or readmission rates between experience levels. However, operative time (230 versus 145 min, P < 0.001) intraoperative blood loss (200 versus 100 ml, P < 0.001) and conversion rate (13.6 versus 2.1 per cent, P = 0.002) all decreased with increasing surgical experience (trainee versus trainer).


CONCLUSIONS
It is safe and feasible to introduce laparoscopic sigmoid colectomy to a structured residency.
Daetwiler
S
S
Department of Surgery, Spital Limmattal, Schlieren, Switzerland.
Guller
U
U
Schob
O
O
Adamina
M
M
D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D003082:Colectomy / Q000009:adverse effects / Q000193:education / Q000592:standards*; D012809:Colon, Sigmoid / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000009:adverse effects / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome