Teaching Colorectal Surgery in the Laparoscopic Era; Is It Safe?

Objectives

With the introduction of laparoscopic colorectal surgery, the question is raised as to whether laparoscopic colectomies can safely be performed by surgical registrars, when supervised by experienced laparoscopic surgeons. In this study we have compared surgical outcomes of surgical registrars, fellows, and staff surgeons in a Dutch teaching hospital.

Design, Setting, and Participants

Using a prospective database, the surgical outcomes of staff surgeons, fellows, and surgical registrars were compared. Pre- and postoperative complications were evaluated, including anastomotic failure. The percentage of reintervention, mortality, readmission, total hospital stay, and operating time were evaluated. The quality of the surgical resection was assessed by comparing the number of resected lymph nodes in malignant cases and the percentage of patients with adequate resection margins.

Results

Analysis was performed in 420 patients. The majority of surgery was performed by staff surgeons. Outcomes of surgery for staff surgeons, fellows, and surgical registrars were comparable with respect to complications, percentage of conversions, and oncological adequacy.

Conclusions

Comprehensive training as a colorectal surgeon should include competence in laparoscopic resections. Our results show that laparoscopic colorectal surgery can safely be performed by surgical registrars with no increase of the number of conversions to laparotomy or the number of complications.

Key Words: laparoscopy, colorectal, surgical registrar, teach, learning curve

Competency: Patient Care, Medical Knowledge, Practice Based Learning and Improvement