Laparoscopy Comparing results of residents and attending surgeons to determine whether laparoscopic colectomy is safe John R. Mehall, M.D., Sahir Shroff, M.D., Steven A. Fassler, M.D., F.A.C.S., Steven G. Harper, M.D., F.A.C.S., F.A.S.C.R.S., Joseph H. Nejman, M.D., F.A.C.S., F.A.S.C.R.S., D. Mark Zebley, M.D., F.A.C.S., F.A.S.C.R.S. Department of Surgery, Abington Memorial Hospital, Abington, PA, USA Department of Surgery, Holy Redeemer Hospital, Meadowbrook, PA, USA Manuscript received April 23, 2004; revised manuscript December 31, 2004 Presented as a poster at the Annual Meeting of the American Society of Colon and Rectal Surgeons, June 23, 2003, New Orleans, LA Abstract Background: This study was undertaken to compare the technical success and outcomes of laparoscopic colectomy performed by resident surgeons (RS) and attending surgeons (AS). Methods: A review of 451 consecutive laparoscopic colectomies performed by 2 surgeons either with or without a general surgery resident. Data reviewed included demographics, diagnoses, operative data, and outcomes. Comparison was made between patients operated on by RS under attending surgeon supervision, and patients operated on by AS alone. Results: Of 451 patients, 324 were operated on by RS and 127 by AS. The mean age and preoperative diagnoses were similar between groups. Operative time was significantly longer in the RS group (155 minutes vs. 128 minutes, P  .05). Blood loss was slightly higher in RS groups but was not statistically significant (191 mL vs. 174 mL, P = .31). The incidence of conversion to an open procedure, postoperative complications, and length of stay were similar between groups. Conclusions: Supervised RS can safely perform laparoscopic colectomy with results similar to AS. RS take longer to perform the procedure than AS. © 2005 Excerpta Medica Inc. All rights reserved. Keywords: Laparoscopy; Colon resection; Resident education; Patient safety The model for surgical education developed in the early 20th century by Halsted and other great surgical leaders has not undergone significant change since that time. When this model was developed, the depth and scope of medical knowledge and surgical techniques were a fraction of current practice. Not only has the volume of medical knowledge dramatically in- creased, advanced technology has found its way into the op- erating room. Surgical practice now includes techniques that utilize fiber optics, digital imaging, and an entirely new set of instruments and techniques. Laparoscopy has given surgeons a minimally invasive approach to many intra-abdominal proce- dures, allowing for less postoperative pain and faster recovery than open procedures. Laparoscopic colon resection has the demonstrated advan- tages of decreased postoperative pain and narcotic use, shorter hospital stay, faster return of bowel function, and fewer met- abolic derangements [1–3]. Prospective randomized studies comparing laparoscopic versus open colectomy have con- firmed decreased pain and length of stay, but are mixed in demonstrating improved quality of life [3,4]. While laparo- scopic techniques are incorporated into general surgery resi- dency training, the teaching methods for residency were de- veloped prior to the technologic advances of today [5]. In response to the need to educate surgical residents and improve their abilities with laparoscopic instruments, laparoscopic trainers were developed. Laparoscopic trainers have been shown to improve resident’s performance at specific tasks * Corresponding author. Suite G-20, Levy Medical Plaza, 1235 Old York Rd., Abington, PA 19001. Tel.: +1-215-517-1250; fax: +1-215-517- 0821. E-mail address: afassler@comcast.net The American Journal of Surgery 189 (2005) 738 –741 0002-9610/05/$ – see front matter © 2005 Excerpta Medica Inc. All rights reserved. doi:10.1016/j.amjsurg.2005.03.018