The learning curve for laparoscopic colectomy: experience of a surgical fellow in an university colorectal unit
This study aimed to evaluate the learning curve for laparoscopic colectomy of a surgical fellow in an university colorectal unit using a structured training protocol.
This study analyzed the data from 100 consecutive patients who had laparoscopic colectomy performed by a surgical fellow between 11/2004 and 12/2007. The structured training protocol required the fellow to assist more than 40 laparoscopic colectomies before embarking on his first case. Rectosigmoidectomy was prioritized during the initial experience. Operative times were analyzed to represent the learning curve. Other outcome data including conversion and operative outcome were also evaluated.
The following procedures were performed: 49 rectosigmoidectomies, 38 right colon resections, and 13 other resections. Median operative time was 150 min, and conversion rate was 1%. Overall postoperative morbidity rate was 28% (major morbidity 3%). Three patients required early reoperation. There was no operative death. Median hospital stay was 8 days. Operative times reached their lowest point at period of cases 45–50, and remained relatively stable afterwards. Comparing the first 50 and second 50 cases, the only difference observed was more frequent presence of a supervisor in the theater in the first 50 cases (74% versus 52%, p = 0.02), while the other parameters including types of procedures, postoperative recovery, hospital stay, and morbidity rate were not different.
Our results indicated that laparoscopic colectomy training can be safely performed under a structured protocol. The surgeon can perform laparoscopic colectomies more independently after 50 cases, without jeopardizing the clinical outcome.
KeywordsColon cancer Laparoscopic colorectal surgery Learning curve Operative time
- 3.Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM, Colon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484PubMedCrossRefGoogle Scholar
- 4.Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20(3):CD003145Google Scholar
- 8.Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial)—multicentre, randomised controlled trial. Lancet 365:1718–1726PubMedCrossRefGoogle Scholar
- 16.Greene FLP, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M (2002) AJCC cancer staging manual, 6th edn. Springer, PhiladelphiaGoogle Scholar
- 17.Marusch F, Gastinger I, Schneider C, Scheidback H, Konradt J, Bruch HP, Kohler L, Barlehner E, Kockerling F, Laparoscopic Colorectal Surgery Study Group (LCSSG) (2001) Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results. Surg Endosc 15:116–120PubMedCrossRefGoogle Scholar
- 18.Choi DH, Jeong WK, Lim SW, Chung TS, Park JI, Lim SB, Choi HS, Nam BH, Chang HJ, Jeong SY (2008) Learning curves for laparoscopic sigmoidectomy used to manage curable sigmoid colon cancer: single-institute, three-surgeon experience. Surg Endosc. doi: 10.1007/s00464-008-9753-y