title: Training residents in laparoscopic colorectal surgery: is supervised surgery safe?
abstract: Colorectal resections are increasingly performed laparoscopically, and training in laparoscopic resections in the Netherlands has shifted from a post-residency fellowship to training in residency. The question remains if this supervised surgery affects short-term patient outcome.
  
  
  
  Between January 2010 and July 2014, 523 consecutive patients, who underwent laparoscopic colorectal resection, were selected from a prospective single-center database. All data were obtained from the maintained database and retrospectively analyzed. We compared the short-term outcome of patients who underwent laparoscopic colorectal surgery by a supervised fifth- or sixth-year resident compared to patients who underwent laparoscopic colorectal surgery performed by a dedicated colorectal surgeon. Statistical analysis was performed using the Chi-square test for categorical variables and the t test for continuous variables.
  
  
  
  Almost 40 % of operations were performed by a resident with an even distribution in type of resection, except for the abdominal-perineal resection (residents vs. surgeon 3.57 vs. 8.26 %, p = 0.04) and the total number of patients who underwent preoperative chemoradiation (resident vs. surgeon 6.66 vs. 20.65 %, p = 0.04). No difference was found in operative time or per-operative blood loss. A higher conversion rate was found when surgery was performed by a supervised resident (residents vs. surgeon 17.34 vs. 9.17 %, p = 0.01), which could be attributed to case selection and one single year. No differences in major complications, oncological outcome and construction of a stoma were found. In the case of minor complications, a significantly increased percentage of bladder retention was found in the surgeon group (residents vs. surgeon 1 vs. 4.6 %, p = 0.03).
  
  
  
  In this study, we found that patient safety and short-term outcome are not adversely affected when laparoscopic colorectal surgery is performed by a supervised fifth- or sixth-year resident.
authors.affiliation: Department of Surgery, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands. hugonijhof@hotmail.com.
authors.forename: H W
authors.identifier: 0000-0003-0170-802X
authors.initials: HW
authors.lastname: Nijhof
authors.affiliation: Department of Surgery, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Silvis
authors.affiliation: Department of Surgery, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands.
authors.forename: R C L M
authors.initials: RCLM
authors.lastname: Vuylsteke
authors.affiliation: Department of Surgery, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands.
authors.forename: S J
authors.initials: SJ
authors.lastname: Oosterling
authors.affiliation: Department of Surgery, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Rijna
authors.affiliation: Department of Surgery, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands.
authors.forename: H B A C
authors.initials: HBAC
authors.lastname: Stockmann
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000193:education*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D008297:Male; D008611:Mentors; D009426:Netherlands; D011183:Postoperative Complications; D011446:Prospective Studies
keywords: Colectomy; Colorectal; Laparoscopic; Resident; Training