The tail of the learning curve for laparoscopic cholecystectomy

Voitk, Andrus J.; Tsao, S. G. S.; Ignatius, Sumi

doi:10.1016/s0002-9610(01)00699-7

Cited by 80 publications

(54 citation statements)

References 2 publications

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“…Além disto, estas lesões são também mais graves 14,15 e ocorrem a despeito da experiência, da habilidade e do treinamento do cirurgião 4,16,17 . 18 . Segundo Melo 19,20 ao se realizar treinamento em videocirurgia, é necessária a aprendizagem de habilidades psicomotoras indispensáveis ao método laparoscópico.…”

Section: Resultados Resultados Resultados Resultados Resultadosunclassified

Curva de aprendizado e lesões iatrogênicas em colecistectomias videolaparoscópicas

Santos

Neto²

2010

Rev. Col. Bras. Cir.

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OBJETIVO: Analisar a proficiência do cirurgião em colecistectomias videolaparoscópicas, de acordo com sua curva de aprendizado, como fator de risco para as lesões iatrogênicas da via biliar principal. MÉTODOS: Estudo retrospectivo de 2285 pacientes submetidos à colecistectomias videolaparoscópicas no Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro no período de janeiro de 1992 a dezembro de 2007. As características dos cirurgiões foram avaliadas através questionário no qual se procurou identificar idade, experiência profissional em cirurgia convencional e laparoscópica e métodos de aprendizado em videocirurgia. RESULTADOS: O número de lesões da via biliar principal neste estudo foi de seis (0,26%), semelhante ao encontrado na literatura mundial. Todas ocorreram na segunda fase da curva de aprendizado, quando os cirurgiões já haviam realizado mais de 50 colecistectomias videolaparoscópicas. CONCLUSÃO: Certificado de habilitação, treinamento prévio e idade dos cirurgiões se relacionaram com as lesões da via biliar principal nesta série. Houve significância estatística na diferença entre as médias dos tempos de experiência dos cirurgiões e sua relação com as lesões.

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Section: Resultados Resultados Resultados Resultados Resultadosunclassified

Curva de aprendizado e lesões iatrogênicas em colecistectomias videolaparoscópicas

Santos

Neto²

2010

Rev. Col. Bras. Cir.

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“…4,7,17–19 To date, patient-specific risk factors for open conversion have been extensively evaluated, 4–7,13–15,20 whereas surgeon-specific factors remain poorly assessed. 7,17,18,21–25 While identification of patient-specific factors may assist in carefully selecting patients for laparoscopic procedures, an understanding of surgeon specific factors may assist the patient and surgical team to make better decisions about procedure selection and technique as well as operative considerations.…”

Section: Discussionmentioning

confidence: 99%

“…2 Since then, various studies have demonstrated that case volume significantly affects the proficiency of a surgeon. 6,7,17,21–25 Liu et al 6 demonstrated that the laparoscopic cholecystectomy conversion rate (LCCR) decreased from 17% in a surgeon's initial 100 cases to 4% when the surgical experience reached between 400 to 500 cases (P<0.05). Synonymous with the learning curve, a “proficiency-gain curve” for surgeons refers to a graphical representation of improving the rate of proficiency in relation to the increasing number of laparoscopic procedures performed.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Cholecystectomy Conversion Rates Two Decades Later

Sakpal

Bindra²,

Chamberlain³

2010

JSLS

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“…However, the benefits for the patient might be smaller than expected and might not justify the additional costs [6, 7]. Conventional laparoscopic surgery can be demanding, potentially attributing to the relatively long learning curve [8]. Robotic assistance in laparoscopy enables stereoscopic vision, improves dexterity [9, 10], and has been proven safe and feasible in a wide variety of surgical procedures including cholecystectomy [11,12,13,14,15].…”

Section: Introductionmentioning

confidence: 99%

First Results after Introduction of the Four-Armed da Vinci Surgical System in Fully Robotic Laparoscopic Cholecystectomy

Heemskerk¹,

R²,

Wg³

et al. 2005

Dig Surg

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Background: Laparoscopic cholecystectomy offers less post-operative pain, less complications, and faster recovery compared with open cholecystectomy. However, laparoscopic surgery can be demanding because of several technical drawbacks. Robotic surgery allows dexterity skills to be performed faster and shortens the learning curve, possibly leading to faster and safer laparoscopic surgery. Methods: In this paper, we report the results of our first 12 cases of fully robotic laparoscopic cholecystectomy using the da Vinci Surgical System, comparing them with 12 cases of conventional laparoscopic cholecystectomy. Using a fourth arm in robotic laparoscopy enables the surgeon to perform surgery without the use of a tableside assistant, leading to non-tiring, tremble-free assistance and reducing salary costs. Primary end points are operating time and costs. Secondary end points are operative complications and duration of admission. Results: Fully robotic cholecystectomy was completed in all 12 cases without increased complication rate and without conversions. However, robotic assistance results in an increased overall operating room stay of 31 min and increased costs of EUR 1,180.62. Conclusion: Fully robotic laparoscopic cholecystectomy is safe and feasible but seems more expensive and time consuming at this moment.

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The tail of the learning curve for laparoscopic cholecystectomy

Cited by 80 publications

References 2 publications

Curva de aprendizado e lesões iatrogênicas em colecistectomias videolaparoscópicas

Curva de aprendizado e lesões iatrogênicas em colecistectomias videolaparoscópicas

Laparoscopic Cholecystectomy Conversion Rates Two Decades Later

First Results after Introduction of the Four-Armed da Vinci Surgical System in Fully Robotic Laparoscopic Cholecystectomy

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