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Inicio Cirugía Española (English Edition) Training periods with experts improve results in colorectal laparoscopic surgery
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Vol. 87. Núm. 1.
Páginas 13-19 (enero 2009)
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Vol. 87. Núm. 1.
Páginas 13-19 (enero 2009)
Acceso a texto completo
Training periods with experts improve results in colorectal laparoscopic surgery
Las estancias de formación con expertos mejoran los resultados en cirugía laparoscópica colorrectal
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1457
Enrique Balén-Rivera
Autor para correspondencia
ebalen@gmail.com

Author for correspondence.
, Javier Suárez-Alecha, Javier Herrera-Cabezón, Francisco Vicente-García, Coro Miranda-Murúa, Ana Calvo-Benito, Cruz Zazpe-Ripa, José Miguel Lera-Tricas
Servicio de Cirugía General, Hospital de Navarra, Pamplona, Spain
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Abstract
Objective

To analyse the effects of training in elective colorectal laparoscopic surgery with a minimum 6 months follow up to assess early and delayed complications, and comparing the first 40 cases in the 1st Period (P-1: 1996–2002) with the 100 cases in the 2nd Period (P-2: 2003–2008). One of the surgeons had 2 training courses between P-1 and P-2.

Material and methods

A total of 66 colorectal resections due to cancer were performed and 74 operations for benign disease. The cases of malignant diseases increased between P-1 and P-2 (P<.001). (odds ratio=0.16).

Results

There number of complex cases increased between P-1 and P-2 (anterior resectionamputation, left hemicolectomy, total colectomy, rectopexy) versus others (sigmoidectomy, right resections) (P<.05), but the mean duration of the operations was reduced by 29 minutes P<01). There were 24% conversions, with no change in P-2 (P=.85). Surgical mortality at 3 months (1.4%) showed no differences (P=.49). The total complications rate (31%) was significantly lower in P-2 (P=.001), because medical complications (P=.05), the more serious surgical complications (with reintervention) (P=.05) and wound infections (P=.0001) were lower. There was no change in the other surgical complications (P=.61). The overall mean stay was 7.8 days (3-36) (median = 6 days), with no differences between P-1 and P-2 (P=.165). Conversion significantly lengthened the mean hospital stay (P=.015) (from 7.2 [5] days to 10.1 [7] days), but there was no increase in complications (P=.31).

Conclusion

Training in colorectal laparoscopy and training periods with experts improve results (duration, complications, more complex surgery). Conversions did not decrease with experience and the hospital stays lengthened, but they were not associated with more complications.

Keywords:
Laparoscopy
Colorectal surgery
Training
Learning curve
Morbidity
Conversions
Resumen
Objetivo

Analizar el efecto del aprendizaje en cirugía electiva laparoscópica colorrectal con seguimiento mínimo de 6 meses para contabilizar complicaciones precoces y tardías mediante la comparación de los primeros 40 casos del primer período (P1) (1996 a 2002) con los 100 casos del segundo período (P2) (2003 a 2008). Entre P1 y P2, uno de los cirujanos realizó 2 estancias formativas.

Material y métodos

Se realizaron 66 resecciones colorrectales por cáncer y 74 intervenciones por enfermedad benigna. Entre P1 y P2 se incrementaron los casos de enfermedad maligna (p<0,001) (odds ratio=0,16).

Resultados

Entre P1 y P2 se incrementaron los casos de intervenciones complejas (resección anterior-amputación, hemicolectomía izquierda, colectomía total, rectopexia) frente a otras (sigmoidectomía, resecciones derechas) (p<0,05), pero se redujo la duración media de las intervenciones en 29 min (p<0,01). Las conversiones alcanzaron el 24%, sin cambiar en P2 (p=0,85). La mortalidad operatoria a 3 meses (1,4%) no mostró diferencias (p=0,49). La tasa total de complicaciones (31%) se redujo significativamente en P2 (p=0,001) a costa de las complicaciones médicas (p<0,05), las quirúrgicas más graves (con reintervención) (p<0,05) y la infección de herida (p<0,0001). Las demás complicaciones quirúrgicas no cambiaron (p=0,61). La estancia media global fue de 7,8 días (3 a 36) (mediana de 6 días), sin diferencias entre P1 y P2 (p=0,165). La conversión alargó significativamente la estancia media (p=0,015) (de 7,2±5 días a 10,1±7 días), pero no incrementó las complicaciones (p=0,31).

Conclusión

El adiestramiento en laparoscopia colorrectal y las estancias de formación con expertos mejoran los resultados (duración, complicaciones, cirugía más compleja). Con la experiencia, las conversiones no disminuyen y alargan la estancia hospitalaria, pero no se asocian a más complicaciones.

Palabras clave:
Laparoscopia
Cirugía colorrectal
Adiestramiento
Curva de aprendizaje
Morbilidad
Conversiones
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This article was used as an oral presentation at the 13th National Meeting of the Spanish Association of Coloproctology (Barcelona, May 27-29, 2009).

Copyright © 2010. Asociación Española de Cirujanos
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