title: Mentored trainees obtain comparable operative results to experts in complex laparoscopic colorectal surgery.
abstract: OBJECTIVE
  The aim of this study is to evaluate the impact of an expert monitoring on the quality and results of laparoscopic reversal of Hartmann's procedure (LRHP) performed by trainee surgeons by comparing their results to the expert's outcomes.
  
  
  METHODS
  Forty-two LRHP were performed between 2000 and 2008 following a step-by-step, standardised, full laparoscopic procedure. Patients operated upon by a senior surgeon were compared to patients operated upon by trainee surgeons while being mentored by the senior surgeon. Operative time, conversion, complications and post-operative outcome were measured.
  
  
  RESULTS
  Each group included 21 patients. All patients underwent LRHP successfully. Two procedures were converted. No significant difference was observed between the expert and the trainees: operative time, 132 min (SD ± 50) vs. 131 min (SD ± 47) and complications (2-14%), 4 vs. 2. Three complications required re-operation, and three other were treated medically, including one dilatation of an anastomosis. Post-operative outcomes were comparable (oral intake, 3 vs. 2 days; post-operative hospital stay, 6 vs. 7.5 days); no mortality occurred.
  
  
  CONCLUSIONS
  Standardisation simplifies this difficult laparoscopic procedure and offers the same outcome whether it is performed by an expert or by mentored trainees. The complications were comparable to those occurring at experienced centres (anastomotic leak or stricture, ureteral injury, re-operation). The expert mentoring does not prevent all complications but can solve intra-operative technical problems, thus improving the trainee's confidence. Mentoring should be promoted as it can be performed locally or remotely using modern interactive technology.
authors.affiliation: IRCAD-EITS Institute, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France.
authors.forename: Federico
authors.initials: F
authors.lastname: Costantino
authors.forename: Didier
authors.initials: D
authors.lastname: Mutter
authors.forename: Jacopo
authors.initials: J
authors.lastname: D'Agostino
authors.forename: Mario
authors.initials: M
authors.lastname: Dente
authors.forename: Joël
authors.initials: J
authors.lastname: Leroy
authors.forename: Hurng Sheng
authors.initials: HS
authors.lastname: Wu
authors.forename: Jacques
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D000328:Adult; D000368:Aged; D003107:Colorectal Surgery / Q000193:education*; D003710:Demography; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000193:education; D010535:Laparoscopy / Q000193:education*; D008297:Male; D008611:Mentors / Q000193:education*; D008875:Middle Aged; D011182:Postoperative Care / Q000193:education; D011361:Professional Competence; D055815:Young Adult