Learning laparoscopic colectomy during colorectal residency: what does it take and how are we doing?

BACKGROUND: The ability to perform a laparoscopic colectomy is an integral part of a young colorectal surgeon's practice. However, the number of resections required during colorectal residency for a surgeon to be very comfortable performing a laparoscopic colectomy independently is poorly defined. Furthermore, the percentage of trainees that achieve this goal also is unknown.
METHODS: An electronic survey designed by the Young Surgeon's Committee of the American Society of Colon and Rectal Surgeons (ASCRS) was sent to graduates completing Accreditation Council for Graduate Medical Education (ACGME) colorectal residencies after publication of the Clinical Outcomes Study Group (COST) trial (2004-2009). The data collected included the number of laparoscopic right (LR), laparoscopic left (LL), and laparoscopic hand-assisted left (HAL) colectomies performed during residency. Trainees were asked to assess whether at the completion of their fellowship they with each case were very comfortable (VC, would perform a laparoscopic colectomy independently), somewhat comfortable (SC, would require assistance from colleagues), or not comfortable (NC, would not perform a laparoscopic colectomy).
RESULTS: Of the 176 (51%) former fellows responding to the survey, 42 (24%) reported performing fewer than 10 LRs, 108 (62%) reported 10 to 30 LRs, and 24 (14%) reported more than 30 LRs during their fellowship. With LR, 13 (7.5%) respondents were NC, 42 (21%) were SC, and 119 (68%) were VC. As reported, 58 fellows (33%) performed fewer than 10 LLs, 92 (53%) performed 10-30 LLs, and 22 (13%) performed more than 30 LLs. With LL, 12.2% were NC, 33.7% were SC, and 54.1% were VC. Most of the fellows (90%) who performed 30 or more LR, LL, or HAL colectomies were VC. On the average, each year's graduating fellows were more comfortable with laparoscopic colectomy than those graduating in previous years (P < 0.002).
CONCLUSIONS: Performing more than 10 LR colectomies and more than 30 LL colectomies provided the vast majority of colorectal residents with the ability to be very comfortable with these procedures as they entered practice. A concerning number of trainees (46% of LL and 24% of LR trainees) did not reach this benchmark. The new general minimal American Board of Colon and Rectal Surgery (ABCRS) requirement of 50 laparoscopic resections seems appropriate but may require definition regarding the side of the procedure.