A community surgery group was reviewed for 1 year after completion of a laparoscopic colon surgery mentoring program.
A formal mentoring protocol had been established between a university center and two surgeons at a community hospital. Over 18 months, concluding August 2007, surgeons were mentored and telementored through 20 laparoscopic colon resections in their local setting. Surgeons tracked their cases for a further 12 months after the mentoring.
From September 2007 to August 2008, 30 colon resections were performed. Three of these resections (1 laparoscopic sigmoid colectomy for fistula and 2 laparoscopic subtotal colectomies) were mentored and telementored as advanced procedures. Of the remaining 27 resections, 15 (56%) were laparoscopic procedures including 9 right and 5 sigmoid colectomies as well as 1 subtotal colectomy. The 15 laparascopic colon resections were performed for cancer (n = 6), polyps (n = 5), diverticular disease (n = 2), Crohn’s disease (n = 1), and colonic inertia (n = 1). Five cases were converted to open surgery (33%) due to adhesions (n = 3), unclear anatomy (n = 1), and equipment failure (n = 1). The mean number of lymph nodes in the cancer cases was 15.3 ± 3.8. Minor postoperative complications occurred in seven cases (47%), three of which involved conversions. These complications included ileus (n = 4), wound abscess (n = 2), cardiac arrhythmia (n = 1), anastomotic bleed (n = 1), and abscess (n = 1). The patients selected for open surgery consisted of seven right and three sigmoid colectomies as well as a splenic flexure resection and a dual resection. The rationale for these open surgeries were transverse colon cancer (n = 4), medical comorbidity (n = 3), colovesicle fistulas (n = 2), rectal lesion (n = 2), and carcinoid tumor (n = 1). The laparoscopic patients were younger (58.2 ± 13.2 vs 73.8 ± 10.6 years; P = 0.003), had longer operating times (124 ± 28 vs 94 ± 38 min; P = 0.026), and a shorter median hospital stay (3 vs 7 days; P = 0.006). The laparoscopic operating time improved over the mentoring experience (124 ± 28 vs 150 ± 43 min; P = 0.046).
The 1-year follow-up evaluation after a longitudinal mentoring program demonstrates excellent incorporation of laparoscopic colon surgery into a community practice with appropriate case selection, quality cancer surgery, and a moderate conversion rate.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Fowler DL, White SA (1991) Laparoscopy-assisted sigmoid resection. Surg Laparosc Endosc 1:183–188
Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopic-assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM, Colon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484
Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AMH, Heath RM, Brown JM (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068
Kemp JA, Finlayson SR (2008) Outcomes of laparoscopic and open colectomy: a national population-based comparison. Surg Innov 15:277–283
Bilimoria KY, Bentrem DJ, Merkow RP, Nelson H, Wang E, Ko CY, Soper NJ (2008) Laparoscopic-assisted vs open colectomy for cancer: comparison of short-term outcomes from 121 hospitals. J Gastrointest Surg 12:2001–2009
Karanicolas PJ, Dubois L, Colquhoun PHD, Swallow CJ, Walter SD, Guyatt GH (2009) The more the better? The impact of surgeon and hospital volume on in-hospital mortality following colorectal resection. Ann Surg 249(6):954–959
Schlachta CM, Sorsdahl AK, Lefebvre K, McCune M, Jayaraman S (2009) A model for longitudinal mentoring and telementoring of laparoscopic colon surgery. Surg Endosc 23:1639–1643
Birch DW, Misra M, Farrokhyar F (2007) The feasibility of introducing advanced minimally invasive surgery into surgical practice. Can J Surg 50:256–260
Birch DW, Asiri AH, de Gara CJ (2007) The impact of a formal mentoring program for minimally invasive surgery on surgeon practice and patient outcomes. Am J Surg 193:589–591
Laparoscopic Colectomy for Curable Cancer (2004) Retrieved 5 April 2008 at http://www.fascrs.org/physicians/position_statements/laparoscopic_colectomy
Smith A, Rumble RB, Langer B, Stern H, Schwartz F, Brouwers M, Members of Cancer Care Ontario’s Laparoscopic Colon Cancer Surgery Expert Panel and Program in Evidence-Based Care (2005) Laparoscopic surgery for cancer of the colon. Retrieved 5 April 2008 at http://www.cancercare.on.ca/pdf/pebc2-20-2s.pdf
Heniford BT, Backus CL, Matthews BD, Greene FL, Teel WB, Sing RF (2001) Optimal teaching environment for laparoscopic splenectomy. Am J Surg 181:226–230
Heniford BT, Matthews BD, Box EA, Backus CL, Kercher KW, Greene FL, Sing RF (2002) Optimal teaching environment for laparoscopic ventral herniorrhaphy. Hernia 6:17–20
Schlachta CM, Mamazza J, Poulin EC (2007) Are transverse colon cancers suitable for laparoscopic resection? Surg Endosc 21:396–399
About this article
Cite this article
Schlachta, C.M., Lefebvre, K.L., Sorsdahl, A.K. et al. Mentoring and telementoring leads to effective incorporation of laparoscopic colon surgery. Surg Endosc 24, 841–844 (2010). https://doi.org/10.1007/s00464-009-0674-1
- Laparoscopic colon surgery