A reliable framework for laparoscopic colorectal surgery based on well-structured and standardized surgical and post-operative protocols

Background: Although the number of colorectal operations performed laparoscopically has increased, it has not yet surpassed the number of laparotomies. The purpose of this single centre study was to determine, using various parameters and following well-structured and standardized surgical and post-operative procedures the safety and clinical outcomes of laparoscopic colorectal resections performed in a regional hospital by a team of surgeons supervised by a specialized in laparoscopic colorectal surgery. Through this process, it was given the opportunity to evaluate the impact of the learning curve by comparing their performance. Methods: From 2012 to 2021, a total of 234 patients with pathology in the colon and rectum underwent laparoscopic colorectal resection. Patients’ case records and histopathology reports were examined for predefined parameters, statistically analysed and compared.Results: The type of operation had a significant effect on operative time (p<0.001). When the duration of operation was correlated to the number of hospitalization days, a significant positive association was found (r=0.173, p=0.012). The patient’s age showed to affect operative time in a proportional way (p=0.004), while the reverse is true for the number of days after 1st surgery (p<0.001). A reduction in operative times was observed for both the specialized and non-specialized surgeons (r=-0.315, p<0.001, rs=-0.324, p<0.001), with a larger decline for specialized surgeon (r=-0.322, p<0.001, rs=-0.360, p<0.001). Conclusions: Taking into consideration all the parameters, it is our belief that through the framework we have implemented, any surgeon can complete uneventfully the learning curve of laparoscopic colorectal surgery, even in a regional hospital.