Training in laparoscopic colorectal surgery - experience of training in a specialist unit.
BACKGROUND
Laparoscopic colorectal surgery, although technically demanding, is an increasingly desirable skill for coloproctologists. We believe that trainees with adequate supervision from an experienced trainer may perform these procedures safely with good outcome.


METHODS
Surgical logbooks of two senior trainees were reviewed over a 2-year period. A case note analysis was then undertaken. Patient data were recorded with regards to age, sex, operation type, American Society of Anesthesia (ASA) grade, conversion, length of hospital stay and complications. Lymph node yield, resection margins and grade of total mesorectal excision were recorded in oncological procedures.


RESULTS
Over the 2-year period, trainees were involved in 140 resections (age range, 23-88 years; ASA grades I-III). Seventy patients were male. Trainees were first assistant in at least 20 cases prior to undertaking the procedures themselves. Trainees performed a total of 71 operations. Median hospital stay was 7 days (range, 2-48 days). There were three conversions. Anastomotic leaks developed in two patients, one requiring a laparotomy. One patient developed small bowel obstruction secondary to a port site hernia, which was repaired laparoscopically. There was one postoperative death. All oncological resection margins were clear with adequate lymphadenectomies. All total mesorectal excisions were Quirke grade III.


CONCLUSIONS
Adequately trained and supervised trainees may perform major colorectal resections without compromising outcome.
Engledow
Alec H
AH
Department of Laparoscopic and Colorectal Surgery, University College London, London, UK. alecengledow@hotmail.com
Thiruppathy
Kumaran
K
Arulampalam
Tan
T
Motson
Roger W
RW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003082:Colectomy / Q000193:education; D015179:Colorectal Neoplasms / Q000601:surgery; D003107:Colorectal Surgery / Q000193:education*; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004739:England; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008611:Mentors; D008875:Middle Aged; D013038:Specialization; D055815:Young Adult