Document Detail


Laparoscopic-assisted colectomy. The learning curve.
MedLine Citation:
PMID:  8553229     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
One hundred fifty consecutive laparoscopic-assisted colectomies performed by a surgical team were analyzed in an attempt to define a learning curve. These colectomies performed by the Norfolk Surgical Group over a 24-month period, were divided chronologically into six groups of 25 patients each. The groups were then compared to determine if any improvement in length of procedure, complication rate, conversion rate, or length of stay developed as experience increased. Colon cancer and diverticular disease were the most common indications for surgery in all groups. Right hemicolectomy, left colectomy, and low anterior resection accounted for the majority of procedures in all groups. A significant decrease in mean operative time, from 250 min to 156 min over the first 35-50 cases was observed before leveling off at approximately 140 min for the remaining group. Intraoperative complications were low in all groups (range zero to two) and did not show any trend. There was no statistically significant difference in the conversion rate (23.3% overall) among the six groups. Length of stay decreased from 6 days in the first two groups to 5 days in the last four groups, although the difference was not statistically significant. The learning curve for laparoscopic-assisted colectomies is longer than appreciated by many surgeons, requiring as many as 35-50 procedures to decrease operative time to baseline. Complications can be kept at an acceptably low level while on the curve if a cautious approach is taken and the surgeon realizes that a prolonged operative time is not only acceptable, but appropriate during this long learning process. A conversion rate of 20-25% at any phase of the learning process may in fact represent a limitation of current technology. When combined with a low complication rate it may be the sign of a careful surgeon.
Authors:
J D Wishner; J W Baker; G C Hoffman; G W Hubbard; R J Gould; S D Wohlgemuth; W K Ruffin; C F Melick
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Surgical endoscopy     Volume:  9     ISSN:  0930-2794     ISO Abbreviation:  Surg Endosc     Publication Date:  1995 Nov 
Date Detail:
Created Date:  1996-02-22     Completed Date:  1996-02-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  1179-83     Citation Subset:  IM    
Affiliation:
Department of Surgery, Eastern Virginia Medical School, Norfolk 23502, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Case-Control Studies
Colectomy / methods*,  statistics & numerical data
Colonic Neoplasms / surgery
Colonic Polyps / surgery
Diverticulum, Colon / surgery
Female
Humans
Intraoperative Complications / epidemiology
Laparoscopy*
Learning
Length of Stay / statistics & numerical data
Male
Postoperative Complications / epidemiology
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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