Early introduction of laparoscopic sigmoid colectomy during residency

Abstract

Background Laparoscopic sigmoid colectomy for benign diseases is becoming the standard of care. However, few residency programmes incorporate the procedure. This study evaluated the safety and feasibility of the early introduction of laparoscopic sigmoid colectomy during residency. Methods From a database of consecutive laparoscopic sigmoid colectomies collected prospectively over 6 years, those for cancer and primary open sigmoid colectomies were excluded. Surgeons were categorized into five levels of experience in colonic surgery. Patient demographics, operative data, complications and conversion rates were assessed. Results A total of 262 sigmoid colectomies were performed by 13 surgeons. American Society of Anesthesiologists grade and diverticular disease classification were similar across the five experience levels. There were no significant differences in morbidity, mortality or readmission rates between experience levels. However, operative time (230 versus 145 min, P < 0·001) intraoperative blood loss (200 versus 100 ml, P < 0·001) and conversion rate (13·6 versus 2·1 per cent, P = 0·002) all decreased with increasing surgical experience (trainee versus trainer). Conclusion It is safe and feasible to introduce laparoscopic sigmoid colectomy to a structured residency.