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Does experience with laparoscopic colorectal surgery influence intraoperative outcomes?

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Abstract

Background

This study aimed to define the management and risk factors for intraoperative complications (IOC) and conversion in laparoscopic colorectal surgery, and to assess whether surgeon experience influences intraoperative outcomes.

Methods

Consecutive patients undergoing laparoscopic colorectal procedures from 1991 to 2005 were analyzed from a longitudinal prospectively collected database. All patients referred to the four surgeons involved in this study were offered a minimally invasive approach. Patient characteristics, perioperative variables, and surgeon experience data were analyzed and compared.

Results

A total of 991 consecutive laparoscopic colorectal procedures were studied. The majority of operations were performed for malignant disease (n = 526, 53%), and most frequently consisted of segmental colonic resections (n = 718, 72%). A total of 85 patients (8.6%) had an IOC. Patients experiencing an IOC had a significantly higher median body weight (75 versus 68 kg, p = 0.0047) and had a higher proportion of previous abdominal surgery (31% versus 20%, p = 0.029). Only 39% of patients suffering an IOC required conversion to open surgery. A total of 126 (13%) cases were converted to open surgery. On multivariable analysis, previous abdominal surgery [odds ratio (OR) 3.40, 95% confidence interval (CI) 1.39–8.35, p = 0.0076] was independently associated with having an IOC and a conversion to open within the same procedure. With increasing experience, individual surgeons were found to operate on heavier patients (p = 0.025), and on patients who had a higher rate of previous intra-abdominal surgery (< 0.0001). Despite these risk factors, the early and late experience demonstrated no significant difference in terms of IOCs (p = 0.54) and conversion to open surgery (p = 0.40).

Conclusions

The majority of IOCs can be managed laparoscopically. With increasing experience surgeons can perform laparoscopic colorectal surgery on a patient population with a greater proportion of previous abdominal surgery and a higher mean body weight without adversely affecting their rates of intraoperative complications or conversion.

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Acknowledgements

The Minimally Invasive Surgery Research Group at the Ottawa Hospital is supported by unrestricted educational grants from Covidien Canada and Storz Canada. G. Martel is supported by a Fellowship award in the area of knowledge translation from the Candian Institutes of Health Research.

Author information

Correspondence to Robin P. Boushey.

Additional information

Oral presentation at the Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons, April 12th, 2008, Philadelphia, PA.

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Bouchard, A., Martel, G., Sabri, E. et al. Does experience with laparoscopic colorectal surgery influence intraoperative outcomes?. Surg Endosc 23, 862–868 (2009). https://doi.org/10.1007/s00464-008-0087-6

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Keywords

  • Laparoscopic colorectal surgery
  • Intraoperative complications
  • Conversion
  • Experience
  • Learning curve