Laparoscopic-assisted colectomy

Abstract

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.

Transanal endoscopic microsurgery: a review

“…10,11 However, in hospitals where surgeons are experienced in minimally invasive operations, the technique is acquired more rapidly. 12,13 Decreased complication rates, hospital stay, blood loss and duration of surgery after gaining experience with TEM have been reported in several studies.…”

Hand-Assisted Laparoscopic Colectomy: A Helping Hand?

“…Numerous studies have evaluated the ''learning curve'' of laparoscopic colectomy. [1][2][3] It is estimated by conventional laparoscopic techniques that the learning curve for laparoscopic colectomy involves at least 20 cases and more likely 50 cases. Although most of these data are older, I believe that the numbers are relevant today.…”

“…Return of bowel function occurred by the third postoperative day for the majority of patients in both groups (HALS 77%, SLS 78%). There was no difference in length of stay (HALS 7.0 days [range, 2-12] versus SLS 6.0 days [range, [2][3][4][5][6][7][8][9][10], p ¼ .25). Severity of postoperative pain and rate of functional recovery were equivalent.…”

Laparoscopic surgery for cancer patients

“…132 Their contention is supported by studies showing that the learning curve (as measured by operative time, complexity of cases, and percentage of conversions to an open procedure) seems to vary from 10 to 60 cases. [139][140][141] Surgeons must try to obtain additional training after these courses and ask for assistance from surgeons who are more experienced with laparoscopic techniques.…”