INTRODUCTION: This study was designed to look at the conversion rates and morbidity associated with laparoscopic operations performed by trainee surgeons ascending the learning curve when they are well supervised by staff surgeons. METHODS: A review of 204 consecutive cases was performed. We defined experienced staff surgeons as those who have performed more than 300 laparoscopic resection cases. The trainee surgeons had less than 50 cases of experience during the study period. All operations were performed by the experienced staff surgeon or by the trainee surgeon with the staff surgeon as the first assistant and supervisor. RESULTS: A total of 204 laparoscopic resections for colorectal cancer were studied. The dissection was D3 in 73% (n = 149) of cases with a mean lymph node harvest of 19.4 nodes (range 1-56). The staff surgeons performed 90 cases and trainees performed 114 cases. Twenty-one cases (10.3%) required conversion. The overall morbidity rate was 17.6% and perioperative mortality rate was 1.5%. On bivariate analysis, trainee surgeons were not found to be significantly associated with a higher conversion risk. Multivariate analysis revealed that only the factor of T3 and above was an independent predictor of conversion (odds ratio (OR) 4.1; 95% confidence interval (CI) 1.09-15.48). Multivariate analysis of risk factors for morbidity revealed that it was not conversion (OR 2.37; 95% CI, 0.86-6.76) but rectal surgery (OR 4.09; 95% CI 2.04-9.9) that was the independent risk factor of morbidity. CONCLUSIONS: Inexperienced surgeons do not cause more conversions or postoperative morbidity in laparoscopic colorectal surgery if they are well supervised. Conversion is not independently associated with increased postoperative morbidity.
INTRODUCTION: This study was designed to look at the conversion rates and morbidity associated with laparoscopic operations performed by trainee surgeons ascending the learning curve when they are well supervised by staff surgeons. METHODS: A review of 204 consecutive cases was performed. We defined experienced staff surgeons as those who have performed more than 300 laparoscopic resection cases. The trainee surgeons had less than 50 cases of experience during the study period. All operations were performed by the experienced staff surgeon or by the trainee surgeon with the staff surgeon as the first assistant and supervisor. RESULTS: A total of 204 laparoscopic resections for colorectal cancer were studied. The dissection was D3 in 73% (n = 149) of cases with a mean lymph node harvest of 19.4 nodes (range 1-56). The staff surgeons performed 90 cases and trainees performed 114 cases. Twenty-one cases (10.3%) required conversion. The overall morbidity rate was 17.6% and perioperative mortality rate was 1.5%. On bivariate analysis, trainee surgeons were not found to be significantly associated with a higher conversion risk. Multivariate analysis revealed that only the factor of T3 and above was an independent predictor of conversion (odds ratio (OR) 4.1; 95% confidence interval (CI) 1.09-15.48). Multivariate analysis of risk factors for morbidity revealed that it was not conversion (OR 2.37; 95% CI, 0.86-6.76) but rectal surgery (OR 4.09; 95% CI 2.04-9.9) that was the independent risk factor of morbidity. CONCLUSIONS: Inexperienced surgeons do not cause more conversions or postoperative morbidity in laparoscopic colorectal surgery if they are well supervised. Conversion is not independently associated with increased postoperative morbidity.
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