Early introduction of laparoscopic sigmoid colectomy during residency

British Journal of Surgery - Tập 94 Số 5 - Trang 634-641 - 2007
Silvia Daetwiler1, Ulrich Güller2, Othmar Schöb1, Michel Adamina1,2
1Department of Surgery, Spital Limmattal, Schlieren, Switzerland
2Institute for Surgical Research and Hospital Management, University of Basel, Basel, Switzerland

Tóm tắt

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.

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Tài liệu tham khảo

Dwivedi, 2002, Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease, Dis Colon Rectum, 45, 1309, 10.1007/s10350-004-6415-6

Gonzalez, 2004, Laparoscopic vs open resection for the treatment of diverticular disease, Surg Endosc, 18, 276, 10.1007/s00464-003-8809-2

Guller, 2003, Laparoscopic vs open colectomy: outcomes comparison based on large nationwide databases, Arch Surg, 138, 1179, 10.1001/archsurg.138.11.1179

Schijven, 2004, Minimal-access surgery training in the Netherlands: a survey among residents-in-training for general surgery, Surg Endosc, 18, 1805, 10.1007/s00464-004-9011-x

Rattner, 2001, The need for training opportunities in advanced laparoscopic surgery, Surg Endosc, 15, 1066, 10.1007/s004640080021

Park, 2002, Ongoing deficits in resident training for minimally invasive surgery, J Gastrointest Surg, 6, 501, 10.1016/S1091-255X(02)00021-5

Nussbaum, 2002, Surgical endoscopy training is integral to general surgery residency and should be integrated into residency and fellowships abandoned, Semin Laparosc Surg, 9, 212, 10.1053/slas.2002.36463

Fowler, 1991, Laparoscopy-assisted sigmoid resection, Surg Laparosc Endosc, 1, 183

Veldkamp, 2005, Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial, Lancet Oncol, 6, 477, 10.1016/S1470-2045(05)70221-7

Pugliese, 2004, Laparoscopic treatment of sigmoid diverticulitis: a retrospective review of 103 cases, Surg Endosc, 18, 1344, 10.1007/s00464-003-9178-6

Alves, 2005, Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study, Arch Surg, 140, 278, 10.1001/archsurg.140.3.278

Alves, 2005, French multicentre prospective observational study of laparoscopic versus open colectomy for sigmoid diverticular disease, Br J Surg, 92, 1520, 10.1002/bjs.5148

Kockerling, 1999, Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group, Surg Endosc, 13, 567, 10.1007/s004649901042

Senagore, 2003, Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience, Dis Colon Rectum, 46, 503, 10.1007/s10350-004-6590-5

Bennett, 1997, The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies, Arch Surg, 132, 41, 10.1001/archsurg.1997.01430250043009

Dincler, 2003, Multidimensional analysis of learning curves in laparoscopic sigmoid resection: eight-year results, Dis Colon Rectum, 46, 1371, 10.1007/s10350-004-6752-5

Schlachta, 2001, Defining a learning curve for laparoscopic colorectal resections, Dis Colon Rectum, 44, 217, 10.1007/BF02234296

Senagore, 1995, What is the learning curve for laparoscopic colectomy?, Am Surg, 61, 681

Accreditation Council for Graduate Medical Education (ACGME), Report of the ACGME Work Group on Resident Duty Hours.

2003, Directive 2003/88/EC of the European Parliament and of the Council of 4 November 2003 concerning certain aspects of the organisation of working time, OJEU, L299, 9

Killelea, 2004, The 80-hour workweek, Surg Clin North Am, 84, 1557, 10.1016/j.suc.2004.06.013

Rageth, 1998, Statistical models with reference to their value for medical process quality assurance, Schweiz Med Wochenschr, 128, 1703

Germer, 2002, Sigmoid diverticulitis. Surgical indications and timing, Chirurg, 73, 681, 10.1007/s00104-002-0506-5

Hansen, 1999, Prophylaktische Operation bei der Divertikelkrankheit des Kolons- Stufenkonzept durch exakte Stadieneinteilung, Langenbecks Arch Chir, 1257

Stock, 2001, Divertikulitis: eine Standortbestimmung, 92, 10.1007/978-3-642-59493-9_13

Kohler, 1999, Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery, Surg Endosc, 13, 430, 10.1007/s004649901007

Wong, 2000, Practice parameters for the treatment of sigmoid diverticulitis—supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons, Dis Colon Rectum, 43, 290, 10.1007/BF02258291

Youngblood, 2005, Comparison of training on two laparoscopic simulators and assessment of skills transfer to surgical performance, J Am Coll Surg, 200, 546, 10.1016/j.jamcollsurg.2004.11.011

Stefanidis, 2005, Skill retention following proficiency-based laparoscopic simulator training, Surgery, 138, 165, 10.1016/j.surg.2005.06.002

Aggarwal, 2006, A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill, Am J Surg, 191, 128, 10.1016/j.amjsurg.2005.10.014

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, 10.1056/NEJMoa032651

Simons, 1995, Laparoscopic-assisted colectomy learning curve, Dis Colon Rectum, 38, 600, 10.1007/BF02054118

Tekkis, 2005, Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections, Ann Surg, 242, 83, 10.1097/01.sla.0000167857.14690.68

Le Moine, 2003, Factors and consequences of conversion in laparoscopic sigmoidectomy for diverticular disease, Br J Surg, 90, 232, 10.1002/bjs.4035

Tekkis, 2005, Conversion rates in laparoscopic colorectal surgery: a predictive model with 1253 patients, Surg Endosc, 19, 47, 10.1007/s00464-004-8904-z

Gervaz, 2001, Converted laparoscopic colorectal surgery, Surg Endosc, 15, 827, 10.1007/s004640080062

Marusch, 2001, Importance of conversion for results obtained with laparoscopic colorectal surgery, Dis Colon Rectum, 44, 207, 10.1007/BF02234294

Renwick, 2005, Effect of supervised surgical training on outcomes after resection of colorectal cancer, Br J Surg, 92, 631, 10.1002/bjs.4935

Tytherleigh, 2002, Surgical specialist registrars can safely perform resections for carcinoma of the rectum, Ann R Coll Surg Engl, 84, 389, 10.1308/003588402760978175

Society of American Gastrointestinal and Endoscopic Surgeons, 2005, Integrating Advanced Laparoscopy into Surgical Residency Training: a SAGES Position Paper.

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British Journal of Surgery

Tập 94 Số 5

634-641

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