title: Does experience with laparoscopic colorectal surgery influence intraoperative outcomes?
abstract: BACKGROUND
  This study aimed to define the management and risk factors for intraoperative complications (IOC) and conversion in laparoscopic colorectal surgery, and to assess whether surgeon experience influences intraoperative outcomes.
  
  
  METHODS
  Consecutive patients undergoing laparoscopic colorectal procedures from 1991 to 2005 were analyzed from a longitudinal prospectively collected database. All patients referred to the four surgeons involved in this study were offered a minimally invasive approach. Patient characteristics, perioperative variables, and surgeon experience data were analyzed and compared.
  
  
  RESULTS
  A total of 991 consecutive laparoscopic colorectal procedures were studied. The majority of operations were performed for malignant disease (n=526, 53%), and most frequently consisted of segmental colonic resections (n=718, 72%). A total of 85 patients (8.6%) had an IOC. Patients experiencing an IOC had a significantly higher median body weight (75 versus 68 kg, p=0.0047) and had a higher proportion of previous abdominal surgery (31% versus 20%, p=0.029). Only 39% of patients suffering an IOC required conversion to open surgery. A total of 126 (13%) cases were converted to open surgery. On multivariable analysis, previous abdominal surgery [odds ratio (OR) 3.40, 95% confidence interval (CI) 1.39-8.35, p=0.0076] was independently associated with having an IOC and a conversion to open within the same procedure. With increasing experience, individual surgeons were found to operate on heavier patients (p=0.025), and on patients who had a higher rate of previous intra-abdominal surgery (p<0.0001). Despite these risk factors, the early and late experience demonstrated no significant difference in terms of IOCs (p=0.54) and conversion to open surgery (p=0.40).
  
  
  CONCLUSIONS
  The majority of IOCs can be managed laparoscopically. With increasing experience surgeons can perform laparoscopic colorectal surgery on a patient population with a greater proportion of previous abdominal surgery and a higher mean body weight without adversely affecting their rates of intraoperative complications or conversion.
authors.affiliation: Minimally Invasive Surgery Research Group, Division of General Surgery, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Road, CCW 1617, Ottawa, ON, Canada K1H 8L6.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Bouchard
authors.forename: Guillaume
authors.initials: G
authors.lastname: Martel
authors.forename: Elham
authors.initials: E
authors.lastname: Sabri
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Schlachta
authors.forename: Eric C
authors.initials: EC
authors.lastname: Poulin
authors.forename: Joseph
authors.initials: J
authors.lastname: Mamazza
authors.forename: Robin P
authors.initials: RP
authors.lastname: Boushey
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003082:Colectomy / Q000379:methods* / Q000592:standards; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D010535:Laparoscopy / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome