Single-incision Laparoscopic Cholecystectomy Learning Curve Experience Seen in a Single Institution

Feinberg, Elyssa; Agaba, Emmanuel A.; Feinberg, Michelle; Camacho, Diego; Vemulapalli, Pratibha

doi:10.1097/sle.0b013e31824799ef

Cited by 24 publications

(7 citation statements)

References 12 publications

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“…In the present study, the surgeon who carried out all of the operations is an experienced laparoscopic surgeon with a personal experience of performing more than 30 SILCs, which is consistent with the number of recommended cases [15]. A longer operative time is not only related to the "inline" visualization of SILC, as after 25-30 cases a surgeon becomes familiar with this new view [17]. The surgeon performed a more meticulous dissection during SILC to guarantee the critical view of safety [12] that inevitably is more demanding for the absence of triangulation.…”

Section: Discussionmentioning

confidence: 57%

Single-incision laparoscopic cholecystectomy versus traditional laparoscopic cholecystectomy performed by a single surgeon: findings of a randomized trial

et al. 2015

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Section: Discussionmentioning

confidence: 57%

Single-incision laparoscopic cholecystectomy versus traditional laparoscopic cholecystectomy performed by a single surgeon: findings of a randomized trial

et al. 2015

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“…[38][39][40] Single port cholecystectomies are performed at our institution by hepatobiliary surgeons -experts in cholecystectomies of any grade of complexity with specific training in single port laparoscopy -while conventional laparoscopic cholecystectomies for uncomplicated gallbladder diseases are performed by all surgeons. This reflects our belief that single port cholecystectomies should be performed by dedicated surgeons.…”

Section: Discussionmentioning

confidence: 99%

Patient preference matters: cholecystectomy for uncomplicated gallbladder diseases should be performed by single port laparoscopy

et al. 2017

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Background: Laparoscopic cholecystectomy for uncomplicated gallbladder diseases (UGD) is a low-complexity procedure with little morbidity. Single port approach (SPA) benefits are unclear. Our aim is to identify any advantages by evaluating both the clinical outcomes of this approach and also patient opinion, following a year of implementation in our institution.Methods: Data from patients operated on during 2015 for UGD by SPA or conventional laparoscopic approach (CLA) were collected. Patients were asked to answer a telephone questionnaire 4-6 months after the operation.Results: 47 patients were operated on by SPA (SP group) and 117 by CLA (CL group). No differences were found between preoperative variables, surgical time, morbidity, length of stay or wound complications. More SP group patients reported no pain at discharge (72.3 vs 54.7%, p=0.037). 138 patients answered the questionnaire. No significant differences were found when comparing overall satisfaction. Wound aspect satisfaction was higher in the SP group (100 vs 80.9%, p=0.001). A higher proportion of CL group patients felt that had they had fewer scars, they would be more satisfied (46.8 vs 9.1%, p <0.001), and 35.1% of them opined that their satisfaction would be greater had they been operated on by SPA. In the multivariate analysis, the only variable associated with maximum overall satisfaction was wound aspect satisfaction.Conclusions: SPA is a valid alternative to CLA for UGD. It should be chosen when available, since it provides equal clinical outcomes, diminishes postoperative pain and is preferred by patients.

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“… 14 Previous experiences in humans have indicated anywhere from a 5- to 75-case learning curve with SILC ( Table 4 ). 12 , 15 – 17 , 20 , 21 These studies did not differentiate surgeons based on their previous level of training and laparoscopic experience. Our results did not show a significant time drop-off after the first 5 to 10 cases for experienced general surgeons performing laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Competence Acquisition for Single-Incision Laparoscopic Cholecystectomy

Giangola

et al. 2015

JSLS

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Background and Objectives:Within the past few years, there has been a push for an even more minimally invasive approach to biliary disease with the adoption of single-incision laparoscopic cholecystectomy. We sought to compare 4 individual surgeon experiences to define whether there exists a learning curve for performing single-incision laparoscopic cholecystectomy.Methods:We performed a retrospective review 290 single-incision laparoscopic cholecystectomies performed by a group of general surgeons, with varying levels of experience and training, at 3 institutions between May 2008 and September 2010. The procedure times were recorded for each single-incision laparoscopic cholecystectomy, ordered chronologically for each surgeon, and subsequently plotted on a graph. The patients were also combined into cohorts of 5 and 10 cases to further evaluate for signs of improvement in operative efficiency.Results:Of the 4 surgeons involved in the study, only 1 (surgeon 4, laparoscopic fellowship trained with <5 years' experience) confirmed the presence of a learning curve, reaching proficiency within the first 15 cases performed. The other surgeons had more variable procedure times, which did not show a distinct trend. When we evaluated the cases by cohorts of 5 cases, surgeon 4 had a significant difference between the first and last cohort. Increased body mass index resulted in a slightly longer operative time (P < .0063). The conversion rate to multiport laparoscopic surgery was 3.1%.Conclusions:Our results indicate that among experienced general surgeons, there does not seem to be a significant learning curve when transitioning from conventional laparoscopic cholecystectomy to single-incision laparoscopic cholecystectomy. The least experienced surgeon in the group, surgeon 4, appeared to reach proficiency after 15 cases. Greater than 5 years of experience in laparoscopic surgery appears to provide surgeons with a sufficient skill set to obviate the need for a single-incision laparoscopic cholecystectomy learning curve.

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Single-incision Laparoscopic Cholecystectomy Learning Curve Experience Seen in a Single Institution

Abstract: The learning curve for successful consistent completion of SILS cholecystectomy cases appears to be after 25 cases. In addition, conversion rates drop dramatically after the first ten cases.

Cited by 24 publications

References 12 publications

Single-incision laparoscopic cholecystectomy versus traditional laparoscopic cholecystectomy performed by a single surgeon: findings of a randomized trial

Single-incision laparoscopic cholecystectomy versus traditional laparoscopic cholecystectomy performed by a single surgeon: findings of a randomized trial

Patient preference matters: cholecystectomy for uncomplicated gallbladder diseases should be performed by single port laparoscopy

Competence Acquisition for Single-Incision Laparoscopic Cholecystectomy

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