title: Teaching colorectal surgery in the laparoscopic era; is it safe?
abstract: OBJECTIVE
  With the introduction of laparoscopic colorectal surgery, the question is raised as to whether laparoscopic colectomies can safely be performed by surgical registrars, when supervised by experienced laparoscopic surgeons. In this study we have compared surgical outcomes of surgical registrars, fellows, and staff surgeons in a Dutch teaching hospital.
  
  
  METHODS
  Using a prospective database, the surgical outcomes of staff surgeons, fellows, and surgical registrars were compared. Pre- and postoperative complications were evaluated, including anastomotic failure. The percentage of reintervention, mortality, readmission, total hospital stay, and operating time were evaluated. The quality of the surgical resection was assessed by comparing the number of resected lymph nodes in malignant cases and the percentage of patients with adequate resection margins.
  
  
  RESULTS
  Analysis was performed in 420 patients. The majority of surgery was performed by staff surgeons. Outcomes of surgery for staff surgeons, fellows, and surgical registrars were comparable with respect to complications, percentage of conversions, and oncological adequacy.
  
  
  CONCLUSIONS
  Comprehensive training as a colorectal surgeon should include competence in laparoscopic resections. Our results show that laparoscopic colorectal surgery can safely be performed by surgical registrars with no increase of the number of conversions to laparotomy or the number of complications.
authors.affiliation: Department of Colorectal Surgery, Royal Brisbane Hospital, Herston, Australia. pmverheijen@gmail.com
authors.forename: Paul M
authors.initials: PM
authors.lastname: Verheijen
authors.forename: Anthony W H
authors.initials: AW
authors.lastname: vd Ven
authors.forename: Paul H P
authors.initials: PH
authors.lastname: Davids
authors.forename: David A
authors.initials: DA
authors.lastname: Clark
authors.forename: Apollo
authors.initials: A
authors.lastname: Pronk
mesh_terms: D002983:Clinical Competence; D003082:Colectomy / Q000193:education*; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D012007:Rectum / Q000601:surgery*; D012449:Safety; D016896:Treatment Outcome