A Selective Policy Ensures Safe Integration of Laparoscopic Colorectal Resection into the Practice of a Newly Appointed Consultant Surgeon

ABSTRACT

Introduction: Integration of laparoscopic colorectal surgery into consultant practice can be a challenge. We present the first year of practice for a suitably trained surgeon using a selective policy. Materials and Methodology: Patients requiring an elective colorectal resection under the care of a newly appointed consultant surgeon were considered for laparoscopic surgery. Exclusion criteria included multiple previous abdominal operations, rectal cancer less than 12cm from the anal verge, radiological/clinical suspicion of tumor involvement of adjacent organs and a mass 6cm. Prospective data collected from August 2007 to August 2008 included types of surgeries, body mass index (BMI), median operating time, lymph node yield, complications, 30 days mortality, length of stay and 30 days readmissions.

Results: Laparoscopic colorectal resection was performed in 42 patients (26 females), with a median age of 65 years (range 14-83 years). There were 18 right hemicolectomies/ileocaecal resections, 15 sigmoid colectomies/high anterior resections, 7 subtotal colectomies and 2 reversal of Hartmann’s. Indications for surgery were colorectal cancer (n=27), inflammatory bowel disease (n=10), diverticular disease (n=3) and others (n=2). There were 5 (11.9%) conversions. Median operating time was 150 minutes (range 75-280 minutes) and BMI was 25.5 (range 16-38). There were no deaths reported. Eight (19%) patients had complications. Median lymph node yield in malignant cases was 13 (range 8-30). Median length of stay was 4 days (range 3 to 20 days) and there were 3 (7%) readmissions.

Conclusions: Laparoscopic colorectal resection can be safely integrated into the practice of a suitably trained, newly appointed consultant surgeon if a selective policy is employed. With greater experience, a less selective policy may become appropriate.