Impact of Training Systems in Laparoscopic Colorectal Surgery. Comparative Analysis of the Learning Curve Between General Surgery Residents, Colorectal Surgery Fellows, and Colorectal Surgeons.

M Galvan, MD, E Grzona, MD, A Canelas, MD, M Bun, MD, M Laporte, MD, C Peczan, MD, N Rotholtz, MD

Colorectal Surgery Division – Hospital Aleman de Buenos Aires. Argentina.

BACKGROUND: Laparoscopic colorectal surgery requires specific training to achieve adequate results. A number of studies show that volume and learning curve are factors that directly affect the outcome. Laparoscopic colectomy is a complex procedure not usually included in the general surgery residency curricula.

OBJECTIVE: The objective of this study is to compare the results when laparoscopic colorectal surgery is perform by colorectal surgeons, colorectal surgery fellows and general surgery residents and determine if the procedure is perform safely during their learning curve.

DESIGN: Retrospective comparative study (prospective database).

PATIENTS AND METHODS: Elective laparoscopic resections of right and left colon for malignant and benign pathology were analyzed in the period between June 2000 and June 2012. The series was divided into three groups: procedures performed by staff colorectal surgeons (GI); colorectal surgery fellows (GII); and general surgery residents (GIII). Patients demographics data; operative time; postoperative recovery variables; length of hospital stay; morbidity and mortality rate were compared. Complex colonic resections as well as rectal surgeries were excluded. The statistical significance level was set at p <0.05. Statistical analysis was performed using the statistical software "SPSS 19".

RESULTS: 619 laparoscopic resections were included. GI: 332 (53.6%), GII: 141 (22.8%) and GIII: 146 (23.6%). Right colectomies were done as follows: GI 96 (15.6%); GII 42 (6.8%); and GIII 62 (10%). Left colectomies: GI 236 (38.1%); GII 99 (15.9%); and GIII 84 (13.6%). There were no differences in parients demographic data between the groups. Conversion rate was higher in GI (GI: 7.5% vs GII: GIII 4.9% vs. 4.7% p <0.05). Intraoperative complications rate was comparable between the groups and there was no difference in recovery parameters. Hospital stay was comparable. The rate of postoperative complications was lower in GI (GI: 72 (21.6%) vs GII: 40 (28.3%) vs GIII: 42 (28.7%), p <0.05). There were no differences in the anastomotic leak rate nor in the mortality rate between the groups.

CONCLUSSION: General surgery residents and colorectal fellows can perform laparoscopic colectomies safely during their training.

Session: Podium Presentation

Program Number: S055

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