Laparoscopic Colon Resection Early in the Learning Curve

Abstract

LCR can be performed safely and with acceptable outcomes early in the learning curve at regional medical centers and university medical centers. Outcomes depend more on surgeons possessing advanced laparoscopic skills and adhering to accepted oncologic surgical principles in cases of malignancy, than on the size or location of the healthcare institution.

Single-Port Laparoscopic Right Hemicolectomy: A Safe Alternative to Conventional Laparoscopy

“…Commonly used surrogates for learning a new technique include operative time, intraoperative blood loss, and conversions. 19,20 When looking specifically at operative time, no difference was noted in either approach. Although clearly some learning curve exists with this technique, no obvious differences were observed with regard to operative times in the earliest and latest cases.…”

Conversion from laparoscopic to open colonic cancer resection – Associated factors and their influence on long-term oncological outcome

“…Likewise Marusch et al [7] report a significantly lower conversion rate in hospitals that conduct more than 100 laparoscopic resections per year and Kuhry et al [8] were able to show, that the conversion rate depends significantly upon the hospital volume. Results of other unicentric and multicentric trials have shown a wide range of conversion rates, from below 5% to above 40% [2,[9][10][11][12][13][14][15], dependent upon the experience at the site and the selection of patients. In the study populations of the CLASSIC trial, the COST trial and the COLOR trial [1,3,4], the conversion rates for elective laparoscopic colon carcinoma resection were respectively 17%, 21% and 17%.…”

Análise de 33 peças cirúrgicas de colectomias laparoscópicas para câncer, durante a curva de aprendizado inicial: margens oncológicas e número de linfonodos não diferem de colectomias abertas

“…Alguns estudos encontraram número inferior aos 12 linfonodos recomendados pela literatura na curva de aprendizado de colectomias laparoscópicas 24,25 . Atribui-se este número inferior a uma linfadenectomia menos minuciosa e a falta de padronização nas técnicas de análise da peça cirúr-gica pelos patologistas 26 .…”

“…A chave para obter maior número de linfonodos durante a ressecção colônica oncológica é isolar e seccionar o pedículo vascular principal próximo a sua emergên-cia na artéria mesentérica superior (colectomias direitas e transversas) ou na aorta (colectomias esquerdas e retossigmoidectomias) 26 .…”