Trainee Learning Curve in Laparoscopic Colorectal Surgery at a District (peripheral) General Hospital

Filippos Sagias, MD, Samer Doughan, MD. QUEEN ELIZABETH THE QUEEN MOTHER HOSPITAL, KENT, UK

Introduction: There are very few studies that analyse the learning curve of colorectal trainees for laparoscopic colorectal resections. Most of the centers that have done so are large academic units. The learning curve of a colorectal trainee at a District General (Peripheral) Hospital has not been established. In our unit there are more than 150 laparoscopic colorectal resections performed each year. The aim of our study was to establish the safety and analyze the outcomes of the initial laparoscopic colorectal resections of a senior registrar that already had some previous advanced laparoscopic experience and was supervised by a single experienced laparoscopic colorectal consultant.
Methods: Following multidisciplinary meeting discussions, the first ten suitable patients, median age of 65 (range 61-74, 5M:5F), were identified and subsequently underwent laparoscopic resections. Six patients (60%) underwent a left-sided resection and four patients (40%) underwent a right hemicolectomy. The ASA grade was 2 (10/10).
Results: The registrar performed 75%-95% of each operation. There were no intra-operative or post-operative complications. There was minimal blood loss and blood transfusion was not required for any of the cases. None of the cases required conversion to open. The median in-hospital stay was four days (range 3-6). One patient was readmitted to hospital after two weeks with abdominal pain which settled within 48 hours. There were no mortalities (0/10). The mean lymph node harvesting was 16 (range 11-26). Histopathology confirmed adenocarcinoma in seven patients (70%) and the other 3 patients (30%) had benign disease.
Conclusion: The initial learning curve of a senior registrar for laparoscopic colorectal resections at a District General (Peripheral) Hospital with a high volume of cases is safe and the outcomes can be equivalent to those of the senior mentor. It is crucial to select the patients appropriately during a multidisciplinary meeting discussion.

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