Competency in laparoscopic colorectal surgery is achievable with appropriate training but takes time: a comparison of 300 elective resections with anastomosis.
OBJECTIVE
The aim of this retrospective cohort study was to compare outcomes in patients who underwent elective laparoscopic colorectal resection with anastomosis performed by a single surgeon or his training fellow.


METHODS
A prospective electronic database of all laparoscopic procedures between January 2005 and September 2008 was used. Two groups were compared; those patients operated upon by the Consultant trainer (C) and those by seven supervised Fellows (F). Fellows were either post CCT or in their last year of training. Three hundred consecutive patients undergoing laparoscopic colorectal resection with anastomosis were examined, 150 in each group. Groups were matched for indication, age, American Society of Anesthesiology (ASA) grade, cancer T stage and resection performed. Preoperative work-up, operative surgery and anaesthesia were identical between groups.


RESULTS
No significant difference was demonstrated in age, mean 67 (26-91) or ASA grade. Indications for surgery were; cancer (C) 120, (F) 126, diverticular disease (C) 22, (F) 20, Crohn's disease (C) 8, (F) 7. Fellow's mean operative time was significantly longer at 123 min (95%CI 117-134) compared to the consultant trainer -105 min. (95%CI 98-111): P < 0.01). No significant differences in the complication or conversion rates were demonstrated. Length of stay and the 30-day readmission rates were similar.


CONCLUSIONS
In this retrospective cohort study we have demonstrate that when matched patients are compared, supervised trainee operating time is significantly longer than that of the consultant trainer but without any significant increase in length of stay, complication or readmission rates. Training to a level of competency takes time but not at the expense of patient care.
Dalton
S J
SJ
Department of Colorectal Surgery, Frenchay Hospital, North Bristol NHS Trust, Bristol, UK.
Ghosh
A J
AJ
Zafar
N
N
Riyad
K
K
Dixon
A R
AR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002983:Clinical Competence; D003092:Colitis / Q000601:surgery; D003106:Colon / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000009:adverse effects / Q000193:education* / Q000379:methods; D003424:Crohn Disease / Q000601:surgery*; D043963:Diverticulosis, Colonic / Q000601:surgery*; D004501:Education, Medical; D017558:Elective Surgical Procedures; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000193:education* / Q000379:methods; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013996:Time and Motion Studies; D016896:Treatment Outcome