Mentored trainees obtain comparable operative results to experts in complex laparoscopic colorectal surgery

被引:10
作者
Costantino, Federico [1 ]
Mutter, Didier [1 ]
D'Agostino, Jacopo [1 ]
Dente, Mario [1 ]
Leroy, Joel [1 ]
Wu, Hurng Sheng [2 ]
Marescaux, Jacques [1 ]
机构
[1] Univ Hosp Strasbourg, IRCAD EITS Inst, F-67091 Strasbourg, France
[2] Show Chwan Mem Hosp, Changhua, Taiwan
关键词
Mentoring; Colectomy; Hartmann's procedure; Training; Laparoscopic colon surgery; HARTMANNS PROCEDURE; REVERSAL;
D O I
10.1007/s00384-011-1290-9
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Purpose The aim of this study is to evaluate the impact of an expert monitoring on the quality and results of laparoscopic reversal of Hartmann's procedure (LRHP) performed by trainee surgeons by comparing their results to the expert's outcomes. Methods Forty-two LRHP were performed between 2000 and 2008 following a step-by-step, standardised, full laparoscopic procedure. Patients operated upon by a senior surgeon were compared to patients operated upon by trainee surgeons while being mentored by the senior surgeon. Operative time, conversion, complications and post-operative outcome were measured. Results Each group included 21 patients. All patients underwent LRHP successfully. Two procedures were converted. No significant difference was observed between the expert and the trainees: operative time, 132 min (SD +/- 50) vs. 131 min (SD +/- 47) and complications (2-14%), 4 vs. 2. Three complications required re-operation, and three other were treated medically, including one dilatation of an anastomosis. Post-operative outcomes were comparable (oral intake, 3 vs. 2 days; post-operative hospital stay, 6 vs. 7.5 days); no mortality occurred. Conclusions Standardisation simplifies this difficult laparoscopic procedure and offers the same outcome whether it is performed by an expert or by mentored trainees. The complications were comparable to those occurring at experienced centres (anastomotic leak or stricture, ureteral injury, re-operation). The expert mentoring does not prevent all complications but can solve intra-operative technical problems, thus improving the trainee's confidence. Mentoring should be promoted as it can be performed locally or remotely using modern interactive technology.
引用
收藏
页码:65 / 69
页数:5
相关论文
共 23 条
[1]  
[Anonymous], 2000, Surg Endosc, V14, P975
[2]   Telesurgery: Remote knowledge translation in clinical surgery [J].
Anvari, Mehran .
WORLD JOURNAL OF SURGERY, 2007, 31 (08) :1545-1550
[3]   Hartmann's reversal is associated with high postoperative adverse events [J].
Aydin, HN ;
Remzi, FH ;
Tekkis, PP ;
Fazio, VW .
DISEASES OF THE COLON & RECTUM, 2005, 48 (11) :2117-2126
[4]  
Grass JA, 2000, LANCET ONCOLOGY, V18, p[407, viii]
[5]  
Haughn C, 2008, DIS COLON RECTUM, V123, P2
[6]   Evaluating the degree of difficulty of laparoscopic colorectal surgery [J].
Jamali, Faek R. ;
Soweid, Asaad M. ;
Dimassi, Hani ;
Bailey, Charles ;
Leroy, Joel ;
Marescaux, Jacques .
ARCHIVES OF SURGERY, 2008, 143 (08) :762-767
[7]   Laparoscopically assisted reversal of Hartmann's procedure [J].
Khaikin, M. ;
Zmora, O. ;
Rosin, D. ;
Bar-Zakai, B. ;
Goldes, Y. ;
Shabtai, M. ;
Ayalon, A. ;
Munz, Y. .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2006, 20 (12) :1883-1886
[8]   Technical aspects and outcome of a standardized full laparoscopic approach to the reversal of Hartmann's procedure in a teaching centre [J].
Leroy, J. ;
Costantino, F. ;
Cahill, R. A. ;
D'Agostino, J. ;
Wu, W. H. S. ;
Mutter, D. ;
Marescaux, J. .
COLORECTAL DISEASE, 2011, 13 (09) :1058-1065
[9]   Trainee Surgeons Do Not Cause More Conversions in Laparoscopic Colorectal Surgery if They Are Well Supervised [J].
Maeda, Takafumi ;
Tan, Kok-Yang ;
Konishi, Fumio ;
Tsujinaka, Shingo ;
Mizokami, Ken ;
Sasaki, Junichi ;
Kawamura, Yutaka J. .
WORLD JOURNAL OF SURGERY, 2009, 33 (11) :2439-2443
[10]   Transatlantic robot-assisted telesurgery [J].
Marescaux, J ;
Leroy, J ;
Gagner, M ;
Rubino, F ;
Mutter, D ;
Vix, M ;
Butner, SE ;
Smith, MK .
NATURE, 2001, 413 (6854) :379-380