From small acorns--developing a laparoscopic colorectal surgical service.
BACKGROUND
Randomised controlled trials have shown that laparoscopic colorectal surgery is equal in terms of safety to open surgery. Benefits have been seen for length of stay, blood loss, immune suppression and analgesia requirements. The aim of this study was to assess the safety and feasibility of introducing laparoscopic colorectal surgery to our unit.


METHODS
Prospectively collected cases of all patients undergoing laparoscopic colorectal surgery between July 2003 and July 2007 were reviewed.


RESULTS
A total of 143 patients (75 males and 68 females) with a mean age of 65.8 years (range, 21-95 years) underwent surgery. Laparoscopic resection for colorectal malignancy was performed in 93 patients (65%). The conversion rate for all cases was 14.7%. Mean operative time was 203 min (range, 100-400 min), with a mean blood loss of 180 ml. The mean number of lymph nodes in malignant cases was 13.8 with clear resection margin in all but one case. The mean postoperative stay was 5.6 days (median, 4 days; range, 2-35 days). UKCCR standard for lymph node retrieval was achieved in 62.6% of cases. There were four postoperative deaths. The overall 30-day morbidity rate was 21.7%. The service is consultant-led with 9.8% of cases performed by senior trainees and 37% of procedures performed by two consultants.


CONCLUSIONS
Laparoscopic colorectal surgery is technically feasible and safe in our hands. Although operative time is longer, this is counterbalanced by shorter hospital stay. The results from this series support the findings of others and continuing development of this service.
Smith
J K
JK
Department of General Surgery, Nottingham University Hospitals, Nottingham, UK. janette.smith@nuh.nhs.uk
Acheson
A G
AG
Simpson
J A D
JA
Stewart
J
J
Beckingham
I J
IJ
Gornall
C B
CB
Williams
J P
JP
Robinson
M H
MH
Maxwell-Armstrong
C A
CA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000458:organization & administration* / Q000592:standards; D003253:Consultants; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D055815:Young Adult