Safe laparoscopic colorectal surgery performed by trainees.

OBJECTIVES

Laparoscopic surgery for colorectal cancer is safe, but there have been hesitations to implement the technique in all departments. One of the reasons for this may be suboptimal learning possibilities since supervised trainees have not been allowed to do the operations to an adequate extent for the technique to spread. We routinely plan all operations as laparoscopic procedures and most cases are done by supervised trainees. The present study therefore presents the results of operations performed by trainees compared with results obtained by experienced laparoscopic surgeons.

DESIGN

Data for all patients who underwent elective colorectal cancer surgery in 2009 were recorded. Surgeries performed by laparoscopic inexperienced surgeons were compared with the outcome of surgery performed by laparoscopic experienced surgeons. These results were also compared with nationwide data extracted from the national database.

SETTING

A university teaching department of surgery.

PARTICIPANTS

A total of 131 patients underwent colorectal elective surgery in 2009 in the department.

RESULTS

Of the 131 operations, 60% were performed by trainees supervised by experienced laparoscopic colorectal surgeons. The trainees performed a total of 70% of all colonic procedures and 43% of all rectal resections. There were no statistically significant differences between the inexperienced and experienced laparoscopic surgeons with regards to short-term outcome other than increased duration of surgery for colonic resections (198 vs 140 min, p = 0.005). Thus, we found no difference regarding length of stay, conversion to laparotomy, intraoperative bleeding or complications, postoperative complications, or 30-day mortality.

CONCLUSIONS

Our data suggest that laparoscopic surgery for colorectal cancer can be performed safely by supervised trainees with good short term results. Therefore, a high volume of operations with an educational potential can easily be maintained when going from open to laparoscopic surgery as the standard operative technique for colorectal cancer in a university department of surgery.