title: Laparoscopic Colectomy and the General Surgeon.
abstract: BACKGROUND
  Laparoscopic colectomy has a shorter length of stay and less analgesic requirements than its open counterpart. Studies have suggested a learning curve of 30 cases. It is uncertain whether surgeons in rural settings have the case volume to acquire and maintain the necessary skill set. The aim of this study was to analyze the volume of colon resections performed by surgeons in rural practice.
  
  
  METHODS
  We performed a retrospective cohort study of the laparoscopic and open partial colectomy case volumes of rural general surgeons seeking American Board of Surgery recertification in 2012. Results were stratified by large and small rural area.
  
  
  RESULTS
  One hundred ninety-seven surgeons were classified as practicing in a rural setting (large rural-150, small rural-47). The median open partial colectomy frequency for large rural surgeons was 7 cases and 4 for small rural surgeons. Median annual partial laparoscopic colectomy volume was 1.0 for large rural surgeons and 0.0 for small rural surgeons. Approximately half of surgeons in both groups did not perform a laparoscopic partial colectomy.
  
  
  CONCLUSIONS
  Industry and financial pressures to promote laparoscopic colectomy may not promote optimal patient outcomes in rural settings, as safety concerns may outweigh the modest benefits of the procedure. Although referral to remote high-volume centers could be advocated, the need for rural general surgeons to perform urgent colectomy for acute indications and the desire of many patients to have care close to home must also be considered.
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, 111 Colchester Ave, Mailstop 320FL4, Burlington, VT, 05401, USA. jesse.moore@uvmhealth.org.
authors.forename: Jesse
authors.initials: J
authors.lastname: Moore
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, 111 Colchester Ave, Mailstop 320FL4, Burlington, VT, 05401, USA. Andrew.pellet@uphs.upenn.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Pellet
authors.affiliation: Department of Surgery, University of Chicago College of Medicine, 5841 S Maryland Ave (MC 5094), Chicago, IL, 60637, USA. nhyman@surgery.bsd.uchicago.edu.
authors.forename: Neil
authors.initials: N
authors.lastname: Hyman
mesh_terms: D002983:Clinical Competence; D003082:Colectomy / Q000706:statistics & numerical data*; D013502:General Surgery; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D019035:Rural Health Services
keywords: Laparoscopic colectomy; Learning curve; Re-certification