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Laparoscopic Colectomy and the General Surgeon.
Jesse Moore1, Andrew Pellet2, Neil Hyman3
1Department of Surgery, University of Vermont College of Medicine, 111 Colchester Ave, Mailstop 320FL4, Burlington, VT, 05401, USA. jesse.moore@uvmhealth.org.
Summary
Rural surgeons have low volumes of laparoscopic colectomy cases, potentially impacting surgical skill acquisition and patient outcomes. Many rural surgeons do not perform this minimally invasive procedure, raising concerns about its feasibility in these settings.
Area of Science:
- Surgical outcomes
- Rural surgery
- Minimally invasive procedures
Background:
- Laparoscopic colectomy offers benefits over open surgery, including shorter hospital stays and reduced pain.
- A learning curve of approximately 30 cases is suggested for laparoscopic colectomy proficiency.
- Concerns exist regarding the ability of rural surgeons to achieve and maintain necessary laparoscopic skills due to case volume.
Purpose of the Study:
- To analyze the case volumes of colon resections performed by surgeons in rural practice.
- To assess the feasibility of laparoscopic colectomy in rural surgical settings.
Main Methods:
- Retrospective cohort study design.
- Analysis of laparoscopic and open partial colectomy case volumes.
- Data collected from rural general surgeons seeking American Board of Surgery recertification in 2012.
- Stratification of results by large and small rural area classifications.
Main Results:
- 197 rural surgeons were included (150 large rural, 47 small rural).
- Median open partial colectomy frequency was 7 cases for large rural and 4 for small rural surgeons.
- Median annual laparoscopic partial colectomy volume was 1.0 for large rural and 0.0 for small rural surgeons.
- Approximately 50% of surgeons in both groups performed no laparoscopic partial colectomies.
Conclusions:
- Promoting laparoscopic colectomy in rural areas may not ensure optimal patient outcomes due to potential safety concerns outweighing benefits.
- Referral to high-volume centers is an option, but rural surgeons' need for urgent colectomies and patient preference for local care are critical considerations.
