Mentoring and Telementoring Leads to Effective Incorporation of Laparoscopic Colon Surgery

OBJECTIVE: To perform a one-year review of a community surgery group following completion of a laparoscopic colon surgery mentoring program.
METHODS: A formal mentoring protocol has been previously reported between a university centre and two surgeons at a community hospital. Over 18 months concluding August 2007, surgeons were mentored and telementored through 20 laparoscopic colon resections in their local setting. Surgeons tracked their cases for a further 12 months following mentoring.
RESULTS: From Sept. 2007 to Aug. 2008, 30 colon resections were performed. Three of these were mentored / telementored as advanced procedures (laparoscopic sigmoid colectomy for fistula, 2 laparoscopic subtotal colectomies). Of the remaining 27, 15 (56%) were laparoscopic. These comprised 9 right, 5 sigmoid colectomies and a subtotal colectomy, for cancer (6), polyps (5), diverticular disease (2), Crohn’s (1) and colonic inertia (1). Five were converted to open surgery (33%) due to adhesions (3), unclear anatomy (1) and equipment failure (1). Mean lymph nodes in cancer cases was 15.3±3.8. Minor postoperative complications occurred in 7 (47%) of which 3 were conversions. These included ileus (4), wound abscess (2), cardiac arrhythmia (1), and anastomotic bleed (1) and abscess (1). Patients selected for open surgery consisted of 7 right, 3 sigmoid colectomies, a splenic flexure resection and a dual resection, the rationale for which were transverse colon cancer (4), medical comorbidity (3), colovesicle fistulae (2), rectal lesion (2) and carcinoid tumor (1). Comparing groups, laparoscopic patients were younger (58.2±13.2 vs.73.8±10.6 yrs, p=0.003), had longer operating time (124±28 vs. 94±38 min, p=0.026) and shorter median hospital stay (3.0 vs. 7.0 d, p=0.006). Laparoscopic operating time improved in this series compared with the mentoring experience (124±28 vs. 150±43, p=0.046).
CONCLUSIONS: One year follow-up after a longitudinal mentoring demonstrates excellent incorporation of laparoscopic colon surgery into a community practice with appropriate case selection, quality cancer surgery and a moderate conversion rate.

Session: Podium Presentation

Program Number: S115

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