The adoption of laparoscopic colorectal surgery: a national survey of general surgeons.
BACKGROUND
Laparoscopic surgery may become the standard of care for the treatment of colorectal disease. Little is known regarding North American patterns of practice or the limiting factors and strategies for adoption among surgeons.


METHODS
We sent a 28-item questionnaire to all general surgeon members of the Royal College of Physicians and Surgeons of Canada. We derived descriptive and correlative information using chi(2), Wilcoxon rank sum and Student t tests and multivariate logistic regression.


RESULTS
The return rate was 55% (694/1266). A total of 67% (462/694; 95% confidence interval 63%-70%) of respondents perform colorectal surgery. Of these, 54% perform laparoscopic colorectal surgery. Multivariate logistic regression identified 5 factors related to performing laparoscopic colorectal surgery: fewer years in practice (p < 0.001), male sex (p = 0.015), practising in the province of Quebec (p = 0.005), university-hospital affiliation (p = 0.034) and minimally invasive surgery fellowship training (p = 0.023). Lack of adequate operating time and formal training were the main reasons cited by surgeons not offering laparoscopic colon resections. Most surgeons (67%) felt that site visits from a minimally invasive surgeon would represent the most effective training method for acquiring advanced laparoscopic skills.


CONCLUSIONS
About half of Canadian general surgeons offer laparoscopic colorectal resections. Recent graduation, male sex, practice location, university-hospital affiliation and minimally invasive surgery training are significant predictors for offering a laparoscopic approach. Lack of operative time and formal training are the main barriers to adoption of the technique. Site visits by trained laparoscopic surgeons is the preferred method of acquiring advanced skills.
Moloo
Husein
H
Minimally Invasive Surgery Research Group, Division of General Surgery, Ottawa Hospital and University of Ottawa, Ottawa, Ont.
Haggar
Fatima
F
Martel
Guillaume
G
Grimshaw
Jeremy
J
Coyle
Doug
D
Graham
Ian D
ID
Sabri
Elham
E
Poulin
Eric C
EC
Mamazza
Joseph
J
Balaa
Fady K
FK
Boushey
Robin P
RP
D000328:Adult; D002170:Canada; D003082:Colectomy / Q000706:statistics & numerical data*; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D013502:General Surgery / Q000639:trends*; D019538:Health Care Surveys; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012002:Rectal Diseases / Q000601:surgery*