The impact of incorporating of a novice assistant into a laparoscopic team on operative outcomes in laparoscopic sigmoidectomy: a prospective study.

AIM: To evaluate whether the incorporation of a novice first assistant into a laparoscopic team affects operative outcomes after laparoscopic sigmoidectomy for sigmoid colon cancer.

METHODS

Sixty-five patients who underwent laparoscopic sigmoidectomy were prospectively enrolled in this study between March 2008 and October 2008. One surgeon with a novice first assistant during the study period carried out all operations. Outcomes of this population were compared with those of 50 patients (control group) that underwent laparoscopic sigmoidectomy between March 2007 and February 2008 by the same surgeon with an experienced first assistant. The 65 patients operated upon with the involvement of the novice (the patients group) were allocated to 2 groups by case number, that is, to an early group (case numbers 1 to 10) and to a late group (case numbers 11 to 65).

RESULTS

Mean operative times were 233+/-50 minutes in the control group, 305+/-113 minutes in the early group, and 226+/-58 minutes in the late group (P=0.04). Multiple regression analysis showed that in the early group, body mass index and tumor diameter significantly contributed to operative time. The incidences of intraoperative and postoperative complications were not significantly different in the early, late, and control groups.

CONCLUSIONS

The incorporation of a novice first assistant into a laparoscopic team was not found to affect operative outcomes adversely. However, in terms of operative time, novice assistants probably need experience of around 10 cases before they can be viewed as fully competent surgical team members during laparoscopic sigmoidectomy.