J. Yasutomi1, K. Kusashio1, M. Matsumoto1, T. Suzuki1, A. Iida1, K. Fushimi1, S. Irabu2, T. Komura2, N. Yamamoto2, N. Imamura1, R. Harano1, A. Yoshizumi1, R. Takayanagi1, N. Matsuyama1, I. Udagawa1 1Chiba Rosai Hospital,Department Of Surgery,Ichihara-city, CHIBA, Japan 2Chiba Rosai Hospital,Department Of Emergency And Intensive Care,Ichihara-city, CHIBA, Japan
Introduction : The technical qualification of the Japanese Society for Endoscopic Surgery requires the operator to lead every operative procedure with initiative throughout the operation. Since leadership and initiative of the operator is regarded as important, relatively high score is given to solo surgery. However, in order to let young surgeons experience laparoscopic colorectal surgeries as operators, the expert support and guiding performed by the assistant should be necessary. The presenting author experienced more than 600 cases as an assistant (mentor). The aim of this study is to justify our educational system of laparoscopic surgery.
Method : ?We analyzed the current status of laparoscopic surgeries. Sigmoid colon resections (n=172) and right hemicolectomies (n=184) were performed from 2011 to 2016 in our institution, in which 87 of the former and 106 of the latter were performed by surgeons in training. The operative data were compared. ?We also classified our laparoscopic colorectal surgeries by the achievement level of the operator. Step 0: A beginner-level surgeon, even if the mentor provides a complete operative field, it is still necessary to assist, or to be replaced by the senior scope holder. Step 1: At the level where the operator can understand and practice the standardized procedure. Step 2: The operator is at the level of the mentor (or the certified surgeon) and leads the entire operation.
Result : ?In recent 8 years, we performed 998 colorectal surgeries including 722 laparoscopic surgeries in our institution. The average number of laparoscopic colorectal surgeries performed by surgeons in training (N=17) was 13 cases per year, and that of laparoscopic cholecystectomies was 38 cases per year. Compared to staff surgeons, we found no significant difference in operative time in sigmoid colon resections—Surgeons in Training ;170min.(SD:37, N=87) , Staff (senior) surgeons:160min.(SD:35,N=85). We could find no significant difference in blood loss either. The surgeons in training performed almost satisfying number of surgeries as operators and no severe complications were experienced.?Among 104/116 laparoscopic colorectal surgeries performed in our hospital in 2015/2016, the number of Step 0 operations were 32/30 cases, whereas Step 1 were 42/57 cases, and Step 2 were 12/11 cases.
Conclusion : Is "Solo Surgery" the Goal of the Laparoscopic Colorectal Surgeries? The answer is "No". An ideal form of the laparoscopic colorectal surgery that we still think is almost the same as traditional open surgery, in which the operator should lead the whole operative procedures and at the same time the assistant should perform a role of harmonious movement with the operator. In order to allow surgeons in training perform laparoscopic colorectal surgeries, our educational system was seemed to be feasible and thought to be the first step for an ideal form of the operation.