Laparoscopic Colon and Rectal Surgery

Surgeon experience with laparoscopic-assisted colorectal surgery in Washington State

PURPOSE

To describe the current practice and opinions held by surgeons performing colorectal surgery in Washington regarding laparoscopic colorectal surgery.

METHODS

After attempting to identify all surgeons with hospital privileges in colorectal surgery in Washington, a survey was sent to 303 surgeons. The survey asked about the surgeon's practice, volume of colon surgery in the preceding year, the number of laparoscopic colon resections ever performed, the surgeon's opinion on the future practice of laparoscopic colorectal surgery, and whether faced with the personal need to undergo colon resection at the present time, would the surgeon elect to have laparoscopic or open colon resection.

RESULTS

In all 170 surveys were returned; 154 returned surveys were from surgeons who had performed at least one colon resection in the preceding year; 53 (34%) respondents had experience with fewer than 20 laparoscopic resections and 83 (55%) have never performed laparoscopic-assisted colectomy (LAC). Only 4 (3%) surgeons had performed more than 50 laparoscopic colon resections. Forty-five percent of respondents indicated that they would currently seek a laparoscopic resection for themselves to treat either a benign condition or an incurable malignancy, and 84% of respondents indicated they would have an open colectomy for a curable malignancy.

CONCLUSIONS

The majority of surgeons performing colorectal resections in Washington have limited experience with LAC. Surgeon opinion regarding the role of laparoscopic colorectal surgery in clinical practice is mixed. We suggest a model for proctoring of LAC for surgeons interested in implementing laparoscopic colorectal resection into their practice.

Initial experience with 150 cases of laparoscopic assisted colectomy

BACKGROUND

Despite multiple reports of large series in the literature over the past decade, laparoscopic assisted colectomy (LAC) has not received widespread acceptance by the surgical community. Critics of LAC note concerns regarding unproved benefits and increased complexity of the procedures. The authors report their initial experience with 150 procedures.

METHODS

A retrospective review of 150 consecutive LACs was performed by the authors.

RESULTS

Mean operative time for completed LAC, converted procedures, right, and sigmoid resections were 164 minutes, 203 minutes, 121 minutes, and 177 minutes, respectively. Twenty-two patients had additional concurrent laparoscopic procedures. Thirty-nine patients had undergone previous abdominal surgery. The conversion rate was 12%. Mean length of stay for all patients was 4.5 days. There were 8 major and 16 minor complications. There were no port site metastases. Major complications and conversion rate decreased from the first 50 cases to the last 50 cases.

CONCLUSIONS

LAC can be safely performed with superior quality of life outcomes in comparison with open colectomy. The authors believe that LAC will eventually become the gold standard for colon resection. The learning curve is discussed as an ongoing process, rather than a set number of procedures.