title: Single-incision laparoscopic colectomy: training the next generation.
abstract: BACKGROUND
  Single-incision laparoscopic colectomy (SILC) is touted to be an improved approach for minimally invasive surgery although no data currently exists regarding the acquisition of skills for the safe performance of this technique. The authors report their early experience with proctoring of surgical residents in SILC by experienced colorectal surgeons.
  
  
  METHODS
  Data regarding patient demographics, operative data, and short-term outcomes were prospectively collected at two surgical training hospitals. Residents and staff independently rated individual components of this technique to compare them with learning standard multiport colectomy (MP).
  
  
  RESULTS
  A total of 31 SILC cases (15 men; mean age 53 years) were managed. The average BMI was 26.5 kg/m(2) (range 16-39 kg/m(2)). The surgical indications included cancer (n = 13), polyps (n = 8), diverticular disease (n = 4), Crohn's disease (n = 2), familial adenomatous polyposis (n = 2), volvulus (n = 1), and rectal prolapse (n = 1). The average operative time was 164 ± 86 min, and the mean blood loss was 80 ± 83 mL. The mean incision length was 4.1 ± 1.1 cm. One case required additional trocar placement (stoma creation), and three cases required conversion to open procedure because of failure to progress, difficult colorectal anastomosis, or poor visualization. The median hospital stay was 5.7 ± 1.3 days. The 30-day morbidity included minor wound infections (9.7 %), ileus (6.5 %), blood transfusion (3.2 %), and intraabdominal abscess (3.2 %). No deaths occurred. Residents rated vascular pedicle isolation, mobilization, critical structure exposure, instrument conflict/handling, and ergonomics as significantly more difficult with SILC.
  
  
  CONCLUSIONS
  Senior-level residents can safely perform SILC under appropriate experienced supervision. The required advanced skills reflect complex laparoscopic training occurring during residency. Opportunities exist for better preparation and training of surgical residents to perform this complex surgery independently and safely at completion of residency.
authors: Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA. seth_l_miller@yahoo.com
authors: Seth
authors: S
authors: Miller
authors: Marlin Wayne
authors: MW
authors: Causey
authors: Aneel
authors: A
authors: Damle
authors: Justin
authors: J
authors: Maykel
authors: Scott
authors: S
authors: Steele
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000193:education* / Q000295:instrumentation / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery; D003108:Colonic Diseases / Q000601:surgery; D003110:Colonic Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education* / Q000295:instrumentation / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008611:Mentors; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D013663:Teaching
references: Colorectal Dis. 2010 Jul;12(7):698-701
references: 19895602
references: Br J Surg. 2006 Aug;93(8):921-8
references: 16845692
references: J Gastrointest Surg. 2008 Mar;12(3):583-91
references: 17846852
references: Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006575
references: 19160288
references: Obes Surg. 2008 Nov;18(11):1492-4
references: 18695946
references: Dis Colon Rectum. 2011 Feb;54(2):187-92
references: 21228667
references: Ann Surg. 1992 Dec;216(6):703-7
references: 1466626
references: J Gastrointest Surg. 2009 Jan;13(1):159-62
references: 18972166
references: Obes Surg. 2008 Dec;18(12):1628-31
references: 18830779
references: Tech Coloproctol. 2010 Sep;14(3):253-5
references: 19953288
references: Dis Colon Rectum. 2009 May;52(5):1021-4
references: 19502875
references: Surg Endosc. 2011 Jul;25(7):2261-7
references: 21359903
references: Surg Endosc. 2005 Sep;19(9):1220-6
references: 16132332
references: Dis Colon Rectum. 1991 Nov;34(11):1030-1
references: 1834447
references: Colorectal Dis. 2010 Sep;12(9):941-3
references: 19895601
references: Int J Colorectal Dis. 2008 Oct;23(10):1013-6
references: 18607608
references: Arch Surg. 2003 Nov;138(11):1179-86
references: 14609864
references: Dis Colon Rectum. 2009 Oct;52(10):1797-801
references: 19966617
references: Surg Endosc. 2010 Apr;24(4):888-90
references: 19760335
references: Colorectal Dis. 2008 Oct;10(8):823-6
references: 18684153
references: J Gastrointest Surg. 2009 Feb;13(2):188-92
references: 19031097
references: Ann Surg. 2012 Apr;255(4):667-76
references: 22258065
references: BJU Int. 2009 Feb;103(4):516-21
references: 18778351
references: Colorectal Dis. 2010 Jan;12(1):61-5
references: 19320667
references: Arch Surg. 2009 Feb;144(2):173-9; discussion 179
references: 19221330
references: Colorectal Dis. 2011 Apr;13(4):393-8
references: 20002691