Abstract
Purpose
A steep learning curve exists for surgeons to become skilled in laparoscopic colon resection. Our institute offers a proctored training programme. The purpose of this descriptive study was to evaluate whether the course resulted in adoption of laparoscopic colorectal surgery into clinical practice, explore post-course practice patterns and analyse the outcome of surgical performance.
Methods
Between 2003 and 2008, 26 surgeons were trained by our institute. The course consisted of 24 elective laparoscopic resections under direct supervision. A questionnaire and a prospective post-course web-based registration were used to analyse the effect of the training and the outcome of surgical performance.
Results
The response rate of the questionnaire was 85%. The majority had not performed any laparoscopic colon resections before attending the course. All 24 respondents successfully implemented laparoscopy into daily practice. After the course, 70% of all sigmoid resections were performed laparoscopically in contrast with 0% of all transverse colon resections. The results of the trainees after following the course are equal to results of other studies.
Conclusions
A proctored training programme, consisting of 24 supervised cases, is safe and feasible. For adequate monitoring, participating in a post-course registry should be obligatory.
Similar content being viewed by others
References
Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1(3):144–150
Abraham NS, Young JM, Soloman MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91:1111–1124
Gutt CN, Oniu T, Schemmer P, Mehrabi A, Buchler MW (2004) Fewer adhesions induced by laparoscopic surgery? Surg Endosc 18:898–906
Dowson HM, Bong JJ, Lovell DP, Worthington TR, Karanjia ND, Rockall TA (2008) Reduced adhesion formation following laparoscopic versus open colorectal surgery. Br J Surg 95:909–914
Laurent C, Leblanc F, Bretagnol F, Capdepont M, Rullier E (2008) Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg 95:903–908
Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Clinical Outcome of Surgical Therapy (COST) Study Group. Short-term qualitiy of life outcomes following laparoscopic-assisted colectomy vs. open colectomy for colon cancer: a randomized trial. JAMA 287(3):321–328
Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484
The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J (2008) Long-term outcome of laparoscopic surgery for colorectal cancer: a cohrande systematic review of randomised trials. Cancer Treat Rev 34:498–504
Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery. Comparison of right-sided and left-sided resections. Ann Surg 242:83–91
Bosker RJI, Hoogenboom FJ, Groen H, Hoff C, Ploeg RJ, Pierie JPEN (2010) Laparoscopic recto-sigmoid resection for diverticular disease is suitable as a training operation. Int J Colorectal Dis 25:471–476
Wal G (2007) Risico's minimaal invasieve chirurgie onderschat. [The Netherlands Health Care Inspectorate website]. November 2007. Available at: http://www.igz.nl/15451/475693/2007-11_Rapport_Minimaal_in1.pdf
Jamali FR, Soweid AM, Dimassi H, Bailey C, Leroy J, Marescaux J (2008) Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg 143(8):762–767
Bartus CM, Lipof T, Sawar CM, Vignati PV, Johnson KH, Sardella WV, Cohen JL (2005) Colovesical fistula: not a contraindication to elective laparoscopic colectomy. Dis Colon Rectum 48(2):233–236
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM, MRC CLASSICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicenter, randomised controlled trial. Lancet 365:1717–1726
Shah PR, Joseph A, Haray PN (2005) Laparoscopic colorectal surgery: learning curve and training implications. Postgrad Med J 81(958):537–540
Fleshman J, Marcello P, Stamos MJ, Wexner SD (2006) Focus Group on Laparoscopic Colectomy Education as endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Guidelines for laparoscopic colectomy course. Surg Endosc 20:1162–1167
Author information
Authors and Affiliations
Corresponding author
Additional information
On behalf of the scientific committee of the Leeuwarden Institute for Minimally Invasive Surgery (LIMIS): S.A. Koopal, MD and E.R. Manusama MD, PhD.
Supplement 1: The questionnaire
Supplement 1: The questionnaire
Rights and permissions
About this article
Cite this article
Bosker, R., Groen, H., Hoff, C. et al. Effect of proctoring on implementation and results of elective laparoscopic colon surgery. Int J Colorectal Dis 26, 941–947 (2011). https://doi.org/10.1007/s00384-011-1161-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-011-1161-4