The benefits of high volume laparoscopic colorectal surgery

Laparoscopic colorectal surgery has become the preferred method of access for virtually all diagnoses and by which essentially every procedure can be performed. Many studies have shown that the benefits of laparoscopic surgery are lost when conversion is necessary as conversion is associated with increased morbidity and mortality and an increased length of hospital stay. In an effort to define the relationships among training in laparoscopy, laparoscopy case volume, and conversion, Massarotti and coworkers evaluated 567 patients. 452 procedures were performed by surgeons who had been trained only in open surgery and 115 operations by surgeons who were trained by the laparoscopic era. Three of the six surgeons were certified in fundamentals of laparoscopic surgery and the number of laparoscopic procedures per surgeon varied from 33 to 207 during this study period. Two of the surgeons were considered as high laparoscopic volume surgeons having contributed more than 100 cases each to the study whereas 4 surgeons were labeled as low laparoscopic volume having contributed less than 100 laparoscopic procedures during this study. The overall conversion rate of 13% including 75% pre-emptive and 25% reactive surgeons. Laparoscopic training and high volume both correlated with lower conversion rates than lack of laparoscopic training and low laparoscopic case volume. This study demonstrated that the type of surgical training was not associated with conversion whereas the volume of laparoscopic surgery did correlate. This finding is similar to many studies of rectal cancer surgery in which higher volume surgeons achieved better outcomes than did lower volume surgeons.