Abstract
Background
Colorectal resections are increasingly performed laparoscopically, and training in laparoscopic resections in the Netherlands has shifted from a post-residency fellowship to training in residency. The question remains if this supervised surgery affects short-term patient outcome.
Methods
Between January 2010 and July 2014, 523 consecutive patients, who underwent laparoscopic colorectal resection, were selected from a prospective single-center database. All data were obtained from the maintained database and retrospectively analyzed. We compared the short-term outcome of patients who underwent laparoscopic colorectal surgery by a supervised fifth- or sixth-year resident compared to patients who underwent laparoscopic colorectal surgery performed by a dedicated colorectal surgeon. Statistical analysis was performed using the Chi-square test for categorical variables and the t test for continuous variables.
Results
Almost 40 % of operations were performed by a resident with an even distribution in type of resection, except for the abdominal–perineal resection (residents vs. surgeon 3.57 vs. 8.26 %, p = 0.04) and the total number of patients who underwent preoperative chemoradiation (resident vs. surgeon 6.66 vs. 20.65 %, p = 0.04). No difference was found in operative time or per-operative blood loss. A higher conversion rate was found when surgery was performed by a supervised resident (residents vs. surgeon 17.34 vs. 9.17 %, p = 0.01), which could be attributed to case selection and one single year. No differences in major complications, oncological outcome and construction of a stoma were found. In the case of minor complications, a significantly increased percentage of bladder retention was found in the surgeon group (residents vs. surgeon 1 vs. 4.6 %, p = 0.03).
Conclusions
In this study, we found that patient safety and short-term outcome are not adversely affected when laparoscopic colorectal surgery is performed by a supervised fifth- or sixth-year resident.
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Authors H. W. Nijhof, R. Silvis, R. C. L. M. Vuylsteke, S. J. Oosterling, H. Rijna, H. B. A. C. Stockmann have no conflicts of interest or financial ties to disclose.
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Nijhof, H.W., Silvis, R., Vuylsteke, R.C.L.M. et al. Training residents in laparoscopic colorectal surgery: is supervised surgery safe?. Surg Endosc 31, 2602–2606 (2017). https://doi.org/10.1007/s00464-016-5268-0
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DOI: https://doi.org/10.1007/s00464-016-5268-0