[Training periods with experts improve results in colorectal laparoscopic surgery].
OBJECTIVE
To analyse the effects of training in elective colorectal laparoscopic surgery with a minimum 6 months follow up to assess early and delayed complications, and comparing the first 40 cases in the 1st Period (P-1: 1996-2002) with the 100 cases in the 2nd Period (P-2: 2003-2008). One of the surgeons had two training courses between P-1 and P-2.


METHODS
A total of 66 colorectal resections due to cancer were performed and 74 operations for benign disease. The cases of malignant diseases increased between P-1 and P-2 (P<0.001). (Odds-Ratio=0.16).


RESULTS
There number of complex cases increased between P-1 and P-2 (Anterior resection-amputation, left hemicolectomy, total colectomy, rectopexy) vs. Others (Sigmoidectomy, right resections) (P<0.05), but the mean duration of the operations was reduced by 29 minutes P<0.01). There were 24% conversions, with no change in P-2 (P=0.85). Surgical mortality at 3 months (1.4%) showed no differences (P=0.49). The total complications rate (31%) was significantly lower in P-2 (P=0.001), because medical complications (P=0.05), the more serious surgical complications (with reintervention) (P=0.05) and wound infections (P=0.0001) were lower. There was no change in the other surgical complications (P=0.61). The overall mean stay was 7.8 days (3-36) (median=6 days), with no differences between P-1 and P-2 (P=0.165). Conversion significantly lengthened the mean hospital stay (P=0.015) (from 7.2+/-5 days to 10.1+/-7 days), but there was no increase in complications (P=0.31).


CONCLUSIONS
Training in colorectal laparoscopy and training periods with experts improve results (duration, complications, more complex surgery). Conversions did not decrease with experience and the hospital stays lengthened, but they were not associated with more complications.
Balén-Rivera
Enrique
E
Servicio de Cirugía General, Hospital de Navarra, Pamplona, España. ebalen@gmail.com
Suárez-Alecha
Javier
J
Herrera-Cabezón
Javier
J
Vicente-García
Francisco
F
Miranda-Murúa
Coro
C
Calvo-Benito
Ana
A
Zazpe-Ripa
Cruz
C
Lera-Tricas
José Miguel
JM
D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000193:education*; D006801:Humans; D010535:Laparoscopy; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome