Impact of a full-time preceptor on the institutional outcome of laparoscopic colectomy.
BACKGROUND
Laparoscopic assisted colectomy (LAC) is a difficult operation with long learning curves and conversion rates inversely proportional to the surgeon's experience. Methods to help train surgeons outside of residency or fellowship programs have been poorly analyzed. This study was undertaken to assess the impact of an experienced laparoscopic surgeon preceptor on the outcome of LAC in a single institution


METHODS
In September 2004, a fellowship-trained laparoscopic surgeon joined our department of surgery. This surgeon served as a LAC preceptor for six inexperienced staff surgeons and four surgical oncology fellows. Clinical and pathologic data from all attempted LAC for the 22 months preceding the arrival of the trained laparoscopic surgeon were compared with those for the 18 months following the recruitment.


RESULTS
Before the addition of the expert surgeon, 28 LAC were performed in our institution, compared with 63 during the preceptor program. These represented 59% and 95% of eligible operations for each time period, respectively (P = 0.005). Overall conversion rates before and after the preceptor's arrival decreased from 44% to 14%, respectively (P < 0.05). The chances of conversion were strongly affected by the presence or absence of the preceptor in the operating room (7% vs. 30%, respectively, P = 0.003). Overall complication rates, hospital stay, blood loss, operative time and number of lymph nodes retrieved were not affected by the presence of the preceptor. Operations completed laparoscopically resulted in significantly lower blood loss and length of stay compared with converted ones.


CONCLUSIONS
A shared departmental preceptor can positively affect the institutional outcome of laparoscopic colectomy. This model may help improve training and patient care in inexperienced centers.
Pigazzi
Alessio
A
Departments of General & Oncologic Surgery, City of Hope National Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA. apigazzi@coh.org
Anderson
Casandra
C
Mojica-Manosa
Pablo
P
Smith
David
D
Hernandez
Kathrina
K
Paz
I Benjamin
IB
Ellenhorn
Joshua D I
JD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002983:Clinical Competence; D003082:Colectomy / Q000193:education / Q000379:methods*; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004502:Education, Medical, Continuing / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011231:Preceptorship / Q000706:statistics & numerical data*; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D017749:Total Quality Management; D016896:Treatment Outcome