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Mentored Trainees have Similar Short-Term Outcomes to a Consultant Trainer Following Laparoscopic Colorectal Resection

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Abstract

Background

Laparoscopic colorectal surgery has a long learning curve. Using a modular-based training programme may shorten this. Concerns with laparoscopic surgery have been oncological compromise and poor surgical outcomes when training more junior surgeons. This study aimed to compare operative and oncological outcomes between trainees undergoing a mentored training programme and a consultant trainer.

Methods

A prospective study of all elective laparoscopic colorectal resections was undertaken in a single institution. Operative and oncological outcomes were recorded. All trainees were mentored by a National Laparoscopic Trainer (Lapco), and results between trainer and trainees compared.

Results

Three hundred cases were included, with 198 (66%) performed for cancer. The trainer undertook 199 (66%) of operations, whilst trainees performed 101 (34%). Anterior resection was the commonest operation (n = 124, 41%). There were no differences between trainer and trainees for the majority of surgical outcomes, including blood loss (p = 0.598), conversion to open (p = 0.113), anastomotic leak (p = 0.263), readmission (p = 1.000) and death rates (p = 0.549). Only length of stay (p = 0.034), stoma formation (p < 0.01) and operative duration (p = 0.007) were higher in the trainer cohort, reflecting the more complex cases undertaken. Overall, there were no significant differences in both short- and longer-term oncology outcomes according to the grade of operating surgeon, including lymph nodes in specimen, circumferential resection margin and 1- and 2-year radiological recurrence.

Conclusion

When a modular-based training system was combined with case selection, both clinical and histopathological outcomes following resectional laparoscopic colorectal surgery were similar between trainees and trainer. This should encourage the use of more training opportunities in laparoscopic colorectal surgery.

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Acknowledgements

The authors wish to thank Professor Parvaiz for his invaluable expertise in developing this modular training technique, enabling the unit to adopt and adapt this approach to training subsequently.

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Authors and Affiliations

  1. Department of Surgery, Queen Alexandra Hospital, Portsmouth, UK

    Henry D. De’Ath

  2. Department of Surgery, Royal Hampshire County Hospital, Winchester, UK

    Laurence Devoto

  3. Department of Surgery, Poole General Hospital, Longfleet Road, Poole, UK

    Chaitanya Mehta, James Bromilow & Tahseen Qureshi

Authors
  1. Henry D. De’Ath
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  2. Laurence Devoto
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  3. Chaitanya Mehta
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  4. James Bromilow
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  5. Tahseen Qureshi
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Corresponding author

Correspondence to Henry D. De’Ath.

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The authors declare no conflict of interest or financial ties to disclose.

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De’Ath, H.D., Devoto, L., Mehta, C. et al. Mentored Trainees have Similar Short-Term Outcomes to a Consultant Trainer Following Laparoscopic Colorectal Resection. World J Surg 41, 1896–1902 (2017). https://doi.org/10.1007/s00268-017-3925-7

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  • DOI: https://doi.org/10.1007/s00268-017-3925-7

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