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The Balance Between Surgical Resident Education and Patient Safety in Laparoscopic Colorectal Surgery

Surgical Resident’s Performance has No Negative Impact

Homma, Shigenori MD, PhD; Kawamata, Futoshi MD, PhD; Yoshida, Tadashi MD, PhD; Ohno, Yosuke MD, PhD; Ichikawa, Nobuki MD, PhD; Shibasaki, Susumu MD, PhD; Kawamura, Hideki MD, PhD; Takahashi, Norihiko MD, PhD; Taketomi, Akinobu MD, PhD

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: August 2017 - Volume 27 - Issue 4 - p 295–300
doi: 10.1097/SLE.0000000000000426
Original Articles

Objective: This study aimed to evaluate the feasibility and effectiveness of a comprehensive theoretical and hands-on training program in performing laparoscopic colonic resections under supervision of an expert surgeon.

Materials and Methods: Laparoscopic right colectomy was performed in 78 patients (10 with benign disease, 68 with carcinoma). Demographic, intraoperative, pathologic examination, and short-term outcome data were retrospectively compared between 25 patients operated by surgical residents (R group) and 53 patients operated by senior surgeons (S group). The residents who performed surgeries in the R group had between 1 and 6 years after graduation; no experience with open or laparoscopic colorectal surgery was necessary. The residents completed a training program under supervision of a single expert laparoscopic colorectal surgeon, which included 6 steps, from basic skills to certification.

Results: There were no differences in patient age, sex, and body mass index between the R and S groups. Significantly more patients in the R group had early cancer and benign lesions (P<0.05). Thirteen of the 16 residents (81.2 %) had not had prior experience with colonic resection. The time of suturing and knot tying in the dry box did not differ between residents and senior surgeons (68 and 69 s, respectively). All the residents performed laparoscopic right colectomy without intraoperative complications. There were no significant differences in operating time (R group: 173±34 min, S group: 172±52 min), mean estimated blood loss (50±111 vs. 49±100 mL), number of lymph nodes dissected (20.8±12.8 vs. 17.1±9.0), and mean postoperative hospital stay (9.1±3.3 vs. 10.7±4.1 d). On the basis of the year of their residency period, all 3 residents at 6 years after graduation had far greater experience than the other residents and therefore performed the surgery with minor verbal support from the expert. However, residents with 1 or 2 years after graduation had to receive guidance provision by the expert during surgery.

Conclusions: When supervised and led by an expert laparoscopic surgeon, surgical residents are capable of performing laparoscopic surgery without negative effects on outcomes.

Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan

S.H. and F.K. contributed equally to this work.

The authors declare no conflicts of interest.

Reprints: Shigenori Homma, MD, PhD, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan (e-mail:

Received October 18, 2016

Accepted April 18, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.