RS06 INTRODUCTION OF LAPAROSCOPIC RESECTIONAL COLORECTAL SURGERY TO NAIVE HOSPITALS

Purpose  Laparoscopic resectional colorectal surgery (LRCS) was introduced to Australia in the early 90’s but gained widespread acceptance only recently. Most published studies demonstrating safety, benefits and acceptable outcomes are from centres with established colorectal units with extensive experience in LRCS. Hospitals looking to introduce this technique realise a long learning curve exists and hence the introduction of LRCS may initially result in a drop in standard of care. It is prudent to ask how and can LRCS be safely introduced to LCRS naïve hospitals. Methods  During introduction of LRCS, surgeons and theatre nurses undertook additional training courses and were encouraged to undertake initial cases with support from a colleague. Clinical pathways were introduced for post operative care. A well established colorectal database was used to prospectively gather data. All LRCS cases during the initial 9 months were included. Comparison is made with non LRCS from the same period, data from the previous year and published studies. Results  95 LRCS cases were studied representing 57% (95/166) of resectional colorectal cases. Of 14 surgeons performing colorectal procedures, 5 undertook LRCS at 2 hospitals previously naïve to LRCS. Favourable results were demonstrated relative to non LRCS performed in the same period compared over major clinical indicators (death, anastomotic leak, return to theatre, unplanned ICU admission, re‐admission). Improvements were observed in length of hospital stay and ICU days. Conclusion  We believe this series demonstrates that LRCS can be rapidly, safely and effectively introduced to a LRCS naïve health service.