How to be impacted on exposing times and dissecting times in laparoscopic sigma resection by surgeon’s skills

Shigehiro Kojima1, Masaaki Ito2. 1Department of Surgery, Sainokuni Higashiomiya Medical Center, 2Department of Colorectal Surgery, National Cancer Center Hospital East

Objective: The aim of this study was to clarify how differences of surgical ability between experts and novices had impacts on exposing times and dissecting times in laparoscopic colectomy for sigmoid colon cancers.                   

Methods: We made up 3 sets of surgical groups by which thirty laparoscopic colectomies for sigmoid colon cancer were performed. Each group was consisted as below; operator was done by expert surgeon and 1st assistant was done by novice surgeon in the first group (E/N), operator was done by novice surgeon and 1st assistant was done by expert surgeon in the second group (N/E) and both were done by novice surgeons in the third group (N/N). Ten laparoscopic sigma resections were performed by each group in the same periods. We also divided surgical procedures of whole laparoscopic sigma resection into ten steps and measure exposing times and dissecting times in all the steps for all patients. We compared the differences of these times among three groups and identified which surgical steps made the major differences among three groups in laparoscopic operation for sigmoid colon cancers.                                                                                        

Results: No differences of clinical backgrounds were observed among three groups with respect to age, sex, body mass index (BMI), and tumor size. Intraoperative outcomes including blood loss, and conversion rate were not significantly different. Total exposing times in the E/N, the N/E, and the N/N groups were 319 (240-571), 375 (141-607), 754 (157-2034) seconds (P = 0.048), and total dissecting times were 2091(1328-3916), 4099 (3125-6194), 4466 (3006-5407) seconds (P < 0.001), respectively. There were the greatest differences between E/N and the others in dissecting times in the surgical step of median to lateral dissection (p<0.001).       

Conclusion: Exposing times were related with the existence of expert surgeon in laparoscopic surgical team regardless expert played an operator’s role or an assistant’s role. On the other hand, dissecting times depended on an operator’s surgical ability and could reduce only by improvements of operator’s skills especially in median to lateral approach in laparoscopic colectomy for sigmoid colon cancers.

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