Laparoscopic colorectal surgery: learning curve and training implications

Aims: This paper is a review of experience of laparoscopic colorectal surgery at a district general hospital with particular emphasis on the learning curve and training implications. Methods: All patients undergoing colorectal surgery where laparoscopy was attempted between March 1998 and October 20...

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Bibliographic Details
Published in:Postgraduate medical journal 2005-08, Vol.81 (958), p.537-540
Main Authors: Shah, P R, Joseph, A, Haray, P N
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Carbon dioxide
Colorectal surgery
Colorectal Surgery - education
Education, Medical, Graduate
Female
General aspects
Hospitals
Hospitals, District
Humans
laparoscopic colorectal surgery
Laparoscopy
Laparoscopy - standards
Learning
learning curve
Male
Medical sciences
Medical Staff, Hospital - education
Middle Aged
Mortality
Older people
Original
Ostomy
Pathology
specialist registrar training
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Trends
Wales
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Summary:Aims: This paper is a review of experience of laparoscopic colorectal surgery at a district general hospital with particular emphasis on the learning curve and training implications. Methods: All patients undergoing colorectal surgery where laparoscopy was attempted between March 1998 and October 2003 were included in this study. Results: There were 80 patients of which 49 had malignancy. Twenty eight stomas and 52 bowel resections were performed laparoscopically. The conversion rate for bowel resection was 32% (decreasing from 38% to 44% to 22%). This was significant (p = 0.001) when compared with stoma formation (7%). The firm has support from a specialist registrar and staff grade surgeon. In 22% of cases, one of the middle grades was the principal operating surgeon, mainly laparoscopic mobilisation and stoma formation. Only 6% of resections were performed by the middle grades. Conversely, a middle grade was the main operating surgeon in 66% of open resections and 61% of stoma formations during the same period. There were in all two deaths and 14 postoperative complications. All patients who had laparoscopic resections for malignancy had clear resection margins. Conclusion: This audit highlights that there is a long learning curve in laparoscopic colorectal surgery with decrease in conversion rates with increasing experience. There is also a reduction in training opportunities in open surgery during the learning phase of the consultant, although this may be counterbalanced by the exposure to laparoscopic techniques. Laparoscopic colonic mobilisation, as a part of stoma formation, is a good starting point for specialist registrar training.
ISSN:0032-5473
1469-0756
DOI:10.1136/pgmj.2004.028100