Mentoring and telementoring leads to effective incorporation of laparoscopic colon surgery

A community surgery group was reviewed for 1 year after completion of a laparoscopic colon surgery mentoring program.

A formal mentoring protocol had been established between a university center and two surgeons at a community hospital. Over 18 months, concluding August 2007, surgeons were mentored and telementored through 20 laparoscopic colon resections in their local setting. Surgeons tracked their cases for a further 12 months after the mentoring.

From September 2007 to August 2008, 30 colon resections were performed. Three of these resections (1 laparoscopic sigmoid colectomy for fistula and 2 laparoscopic subtotal colectomies) were mentored and telementored as advanced procedures. Of the remaining 27 resections, 15 (56%) were laparoscopic procedures including 9 right and 5 sigmoid colectomies as well as 1 subtotal colectomy. The 15 laparascopic colon resections were performed for cancer (n = 6), polyps (n = 5), diverticular disease (n = 2), Crohn's disease (n = 1), and colonic inertia (n = 1). Five cases were converted to open surgery (33%) due to adhesions (n = 3), unclear anatomy (n = 1), and equipment failure (n = 1). The mean number of lymph nodes in the cancer cases was 15.3 + or - 3.8. Minor postoperative complications occurred in seven cases (47%), three of which involved conversions. These complications included ileus (n = 4), wound abscess (n = 2), cardiac arrhythmia (n = 1), anastomotic bleed (n = 1), and abscess (n = 1). The patients selected for open surgery consisted of seven right and three sigmoid colectomies as well as a splenic flexure resection and a dual resection. The rationale for these open surgeries were transverse colon cancer (n = 4), medical comorbidity (n = 3), colovesicle fistulas (n = 2), rectal lesion (n = 2), and carcinoid tumor (n = 1). The laparoscopic patients were younger (58.2 + or - 13.2 vs 73.8 + or - 10.6 years; P = 0.003), had longer operating times (124 + or - 28 vs 94 + or - 38 min; P = 0.026), and a shorter median hospital stay (3 vs 7 days; P = 0.006). The laparoscopic operating time improved over the mentoring experience (124 + or - 28 vs 150 + or - 43 min; P = 0.046).

The 1-year follow-up evaluation after a longitudinal mentoring program demonstrates excellent incorporation of laparoscopic colon surgery into a community practice with appropriate case selection, quality cancer surgery, and a moderate conversion rate.