title: Can community surgeons perform laparoscopic colorectal surgery with outcomes similar to tertiary care centres?
abstract: BACKGROUND
  The use of the laparoscopic approach in colorectal surgery (LCS) is the subject of active debate. Studies demonstrating its safety and feasibility in tertiary care centres are now available. The aim of this study was to examine the results of LCS performed in a community hospital setting.
  
  
  METHODS
  We prospectively studied 100 patients who underwent an LCS at the North Bay District Hospital (a 200-bed community hospital located 350 km away from the nearest tertiary care centre). All operations were performed by 2 community surgeons who transitioned themselves from an open to a laparoscopic approach.
  
  
  RESULTS
  Between October 2000 and December 2003, 100 patients (56 women and 44 men, mean age 64 yr) underwent an LCS for benign (n = 54) and malignant (n = 46) disease. Median operating time was 165 minutes (range 70350 min), and the conversion rate was 10%. The intraoperative complication rate was 3%. There were 10 major postoperative complications and 14 minor postoperative complications. There was no intraoperative mortality and one 30-day mortality secondary to cardiogenic shock. The median length of stay was 4.5 days (range 245 d). At a mean follow-up of 18 months, no trocar site or wound recurrences were noted. The mean number of resected lymphnodes was 10.6.
  
  
  CONCLUSIONS
  Our study suggests that it is possible for community surgeons to transition themselves from an open to a laparoscopic approach and to perform LCS with outcomes similar to those of tertiary care centres.
authors.affiliation: Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont., and the North Bay District Hospital, North Bay, Ont., Canada.
authors.forename: Herawaty
authors.initials: H
authors.lastname: Sebajang
authors.forename: Susan
authors.initials: S
authors.lastname: Hegge
authors.forename: Craig
authors.initials: C
authors.lastname: McKinley
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003108:Colonic Diseases / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006764:Hospitals, Community; D006767:Hospitals, District; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome