Laparoscopic colon resection: A newly established single practice center and a single-surgeon observational study

Background: Laparoscopic surgery has a well-documented role in colon resection with improved postoperative outcomes even in low-volume centers. Recently, we have integrated minimally invasive laparoscopic resection, followed by the enhanced recovery after surgery (ERAS) protocol, to improve postoperative outcomes in our hospital. Objectives: To review our experience of laparoscopic colonic resection with the ERAS protocol and compare our outcomes with those in the literature. Design: Observational retrospective. Setting: Governmental tertiary hospital. Materials (Patients) and Methods: Data of patients over 18 years of age who had undergone laparoscopic colonic resection between January 2016 and December 2021 were retrospectively obtained from medical records. Patients with trauma-related injuries were excluded. The variables collected included patient demographics, disease information, operative and postoperative data, and histopathological reports. Data were compared with similar published studies and landmark trials. Sample Size: 92 patients. Main Outcome Measures: Rates of conversion to open procedure, number of lymph nodes harvested, hospital length of stay, percentage of positive margins, 30-day morbidity, and 30-day mortality. Results: During the study period, 92 patients (59% men) underwent laparoscopic colon resections, of which eight (8.6%) required an open procedure. The average operative time was 233 minutes, and the average intraoperative blood loss was 78 mL. Intraoperative complications occurred in four cases with no postoperative sequelae. The median length of hospital stay was 5 days. Malignant specimens revealed 100% disease-free margins with an average of 22 lymph nodes harvested. The postoperative 30-day morbidity, mortality, and histopathological results were comparable with landmark trials. Conclusion: As a new technique in a low-volume center, laparoscopic colon resection was challenging. Despite the presence of an experienced laparoscopic surgeon, extensive training was required to safely complete the procedure within a reasonable operative time with a successful outcome. Furthermore, the implementation of the ERAS protocol was difficult; however, the team mastered it after the first few cases. This study showed that both efficacy and safety can be achieved in laparoscopic colon resections in low-volume centers. Moreover, the ERAS protocols can be implemented; however, their implementation will require additional training, which may lead to better outcomes. Limitations: The lack of general surgery wards in a busy tertiary trauma center meant that patients with variable wound contamination would share the same unit. Conflict of Interest Statement: None. Number of similar cases published: N/A.