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ASSESSING
THE LEARNING CURVE FOR LAPAROSCOPIC COLORECTAL SURGERY – LESSONS LEARNED
FROM OUR FIRST FORTY PATIENTS
Hila Hermon, Ron Greenberg, Eliad Karin,
Yael Sobol, Eviatar Nesher, Moshi Shimcha, Ofer Kaplan, Yehuda Skornick, Shmuel
Avital
Department Of
Surgery A, Tel
Aviv Medical
Center and The
Sackler Faculty Of Medicine,
Tel Aviv University,
Tel Aviv, Israel
Introduction: Recent data regarding the
oncological safety of laparoscopic colectomy for cancer combined with its potential
benefits would motivate more surgeons to perform laparoscopic colorectal
surgery.
Purpose: To assess factors related to the
learning curve of laparoscopic colorectal surgery with emphasis on number
of operations performed, type of procedures, major complications and
oncological resections.
Methods:
Evaluation of a prospective data collection of our first 40
laparoscopic colorectal surgeries performed in the past year with a
comparison between the first 20 cases to the following 20.
Results: There were 18 males (45%) and 22
females (55%). Mean age was 68 years. Indications included cancer in 21
patients (52.5%), irretrievable Polyps in 7 (17.5%), diverticular disease
in 6 (15%), and others in 6 (15%). Seventeen (42.5%) patients underwent
right colectomy, 10 (25%) sigmoidectomy, 4 (10%) anterior-resection, 2 (5%)
ileocecectomy and 7 (17%) other procedures. Six cases (15%) were converted.
Mean operative-time was 170 minuets. Two patients (5%) died (one from PE
and one secondary to his background illness). Significant surgical
complications occurred in 6 patients (15%). There were no wound infections.
Hospital stay averaged 9.3 days.
Comparison of the first 20 procedures to the
next twenty revealed a significant decrease in major surgical complications
(25% versus 5%). There was no difference in minor complications,
conversions and operative-times. Mean number of harvested nodes was 15 in the first group and
20 in
the second. All margins were negative.
Right colectomies had shorter operative-times
(149 min vs 201 min) and lower conversion rate (0% vs 26%).
Conclusions: There is a significant
decrease in major complications rate after the first 20 laparoscopic
colorectal procedures. Appropriate oncological resection and the benefit of
negligible wound infections-rate are achieved early in the learning curve.
Right colectomies are easier to perform and are recommended as initial
operations.
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