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Supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons

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Abstract

Background

The use of laparoscopic colectomy is becoming widespread and acquisition of its technique is challenging. In this study, we investigated whether supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons.

Methods

The outcomes of 23 right colectomies and 19 high anterior resections for colon cancers performed by five novice surgeons (experience level of <10 cases) between 2014 and 2016 were assessed. A laparoscopic surgeon qualified by the Endoscopic Surgical Skill Qualification System (Japan Society for Endoscopic Surgery) participated in surgeries as the teaching assistant.

Results

In the right colectomy group, one patient (4.3%) required conversion to open surgery and postoperative morbidities occurred in two cases (8.6%). The operative time moving average gradually decreased from 216 to 150 min, and the blood loss decreased from 128 to 28 mL. In the CUSUM charts, the values for operative time decreased continuously after the 18th case, as compared to the Japanese standard. The values for blood loss also plateaued after the 18th case. In the high anterior resection group, one patient (5.2%) required conversion to open surgery and no postoperative complication occurred in any patient. The operative time moving average gradually decreased from 258 to 228 min, and the blood loss decreased from 33 to 18 mL. The CUSUM charts showed that the values of operative time plateaued after the 18th case, as compared to the Japanese standard. In the CUSUM chart for blood loss, no distinguishing peak or trend was noted.

Conclusions

Supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons. The trainee’s learning curve in this study represents successful mentoring by the laparoscopic surgeon qualified by the Endoscopic Surgical Skill Qualification System.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan

    Nobuki Ichikawa, Shigenori Homma, Tadashi Yoshida, Yosuke Ohno, Hideki Kawamura & Akinobu Taketomi

  2. Department of Surgery, Iwamizawa Municipal Hospital, West 7-2, 9 jou, Iwamizawa, 068-8555, Japan

    Nobuki Ichikawa & You Kamiizumi

  3. Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, 060-8638, Japan

    Hiroaki Iijima

Authors
  1. Nobuki Ichikawa
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  2. Shigenori Homma
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  3. Tadashi Yoshida
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  4. Yosuke Ohno
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  5. Hideki Kawamura
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  6. You Kamiizumi
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  7. Hiroaki Iijima
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  8. Akinobu Taketomi
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Contributions

This research did not receive any specific grant funding from agencies in the public, commercial, or not-for-profit sectors.

Authors’ contributions

NI, SH, and AT conceived the idea for this study and developed it in collaboration with YO, TY, HK, and YK. NI was the principal investigator and was responsible for all data collection. NI and HI performed statistical analyses. All authors participated in interpretation and analysis of the data, revised the manuscript, and read and approved the final version.

Corresponding author

Correspondence to Nobuki Ichikawa.

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Disclosures

Drs. Nobuki Ichikawa, Shigenori Homma, Tadashi Yoshida, Yosuke Ohno, Hideki Kawamura, You Kamiizumi, Hiroaki Iijima, and Akinobu Taketomi have no conflicts of interest or financial ties to disclose.

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Ichikawa, N., Homma, S., Yoshida, T. et al. Supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons. Surg Endosc 32, 436–442 (2018). https://doi.org/10.1007/s00464-017-5701-z

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  • DOI: https://doi.org/10.1007/s00464-017-5701-z

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