title: Impact of tutorial assistance in laparoscopic sigmoidectomy for acute recurrent diverticulitis.
abstract: OBJECTIVE
  Adequate training and close supervision by an experienced surgeon are crucial to assure the patient safety during laparoscopic training. This study evaluated the impact of tutorial assistance on the duration of surgery and postoperative complications after laparoscopic sigmoidectomy.
  
  
  METHODS
  The data from 235 patients undergoing laparoscopic sigmoidectomy were collected. Operating surgeons were classified as either residents/registrars (group A, tutorial assistance) or consultants operating autonomously (group B). Groups were compared concerning the duration of surgery and in-hospital complications using a multivariable regression model accounting for the most relevant confounders.
  
  
  RESULTS
  The median duration of the operation in group A (n = 75) was 221 min, and that in group B (n = 160) 189 min (p < 0.001). The risk of developing any in-hospital complication (Clavien-Dindo classification I-V) was 36.0 % in Group A and 32.5 % in group B (95 % CI -16.6, 9.6 %). The risk of developing moderate to severe surgical complications (Clavien-Dindo classification II-V) was 16.0 % in group A and 12.5 % in group B (95 % CI -13.3, 6.3 %).
  
  
  CONCLUSIONS
  We were unable to demonstrate a clear impact of tutorial assistance on the risk of postoperative complications. Although associated with a longer duration of surgery, laparoscopic sigmoidectomy for acute recurrent sigmoid diverticulitis conducted by a junior supervised surgeon appears to be a safe surgical modality.
authors.affiliation: Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland, henry.hoffmann@usb.ch.
authors.forename: Henry
authors.initials: H
authors.lastname: Hoffmann
authors.forename: Salome
authors.initials: S
authors.lastname: Dell-Kuster
authors.forename: Jörg
authors.initials: J
authors.lastname: Genstorfer
authors.forename: Oleg
authors.initials: O
authors.lastname: Heizmann
authors.forename: Christoph
authors.initials: C
authors.lastname: Kettelhack
authors.forename: Igor
authors.initials: I
authors.lastname: Langer
authors.forename: Daniel
authors.initials: D
authors.lastname: Oertli
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosenthal
mesh_terms: D000208:Acute Disease; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000193:education* / Q000379:methods; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061214:Patient Safety; D011183:Postoperative Complications / Q000517:prevention & control; D012008:Recurrence; D012044:Regression Analysis; D012306:Risk; D012810:Sigmoid Diseases / Q000601:surgery*