A model for longitudinal mentoring and telementoring of laparoscopic colon surgery.

OBJECTIVE

To demonstrate the feasibility of longitudinal mentoring and telementoring of community surgeons in laparoscopic colon surgery.

METHODS

A mentoring protocol was established between a university centre and surgeons at a community hospital 60 km away. The community surgeons (CS) attended a course on laparoscopic colon surgery before observing surgery at the mentoring institution. Patients were identified from the CS practice and referred for formal consultation with the mentor. The mentor worked with the same two CS on every case in their local hospital. Procedure outcomes were recorded using Canadian Advanced Endoscopic Surgery Registry (CAESaR) practice audit software. The mentoring endpoint was 20 cases based on American Society of Colon and Rectal Surgeons (ASCRS)/Society of Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines.

RESULTS

From March 2006 to August 2007, 40 patients underwent elective colon surgery by the CS, 20 of whom were referred and accepted for laparoscopic mentoring. After nine cases the MS did not scrub. Beginning with case 15, procedures were telementored except for a subtotal colectomy for which the MS assisted. Patients selected for mentoring (7 female, 13 male) compared with open cases (8 female, 12 male) were younger (60 +/- 13 years versus 72 +/- 17 years, p = 0.013), less likely to have cancer (50% versus 70%, p = 0.33)) and tended to require less complex resections. There were no conversions. Mentored cases took longer (150 +/- 43 min versus 108 +/- 40 min, p = 0.003) but resulted in shorter hospital stay (median 2.5 versus 7.0 days, p < 0.001). Median number of lymph nodes were equivalent in cancer resections (13 versus 12, p = 0.465) There were no technical difficulties with telementoring. Data will be recorded for a further 1 year to assess adoption rate and outcomes.

CONCLUSIONS

This project demonstrates the feasibility of longitudinal mentoring and telementoring of laparoscopic colon surgery for cancer. This program may serve as a model for safe technology transfer to the community.