Skip to main content

Defining a Learning Curve for Laparoscopic Cardiomyotomy

World Journal of Surgery volume 32, pages 1689–1694 (2008)Cite this article

Abstract

Background

This study was designed to determine whether there is a learning curve for laparoscopic cardiomyotomy for the treatment of achalasia.

Methods

All patients who underwent a primary laparoscopic cardiomyotomy for achalasia between 1992 and 2006 in our hospitals were identified from a prospective database. The institutional and the individual surgeon’s learning experiences were assessed based on operative and clinical outcome parameters. The outcomes of cardiomyotomies performed by consultant surgeons versus supervised trainees also were compared.

Results

A total of 186 patients met the inclusion criteria; 144 procedures were undertaken by consultant surgeons and 42 by a surgical trainee. The length of operation decreased after the first ten cases in both the institutional and each individual experience. The rate of conversion to open surgery also was significantly higher in the first 20 cases performed. Intraoperative complications, overall satisfaction with the outcome, reoperation rate, and postoperative dysphagia were not associated with the institutional or the surgeon’s operative experience. Although the length of the operation was greater for surgical trainees (93 versus 79 minutes; p  < 0.01), no differences in outcome between the operations performed by consultant surgeons and surgical trainees were detected.

Conclusion

An institutional (20 cases) and an individual (10 cases) learning curve for laparoscopic cardiomyotomy for achalasia can be defined. The clinical outcome for laparoscopic cardiomyotomy does not differ between supervised surgical trainees and consultant surgeons.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Abir F, Modlin I, Kidd M, Bell R (2004) Surgical treatment of achalasia: current status and controversies. Dig Surg 21:165–176

    PubMed  Article  Google Scholar 

  2. Ramacciato G, Mercantini P, Amodio PM, Corigliano N, Barreca M, Stipa F, Ziparo V (2002) The laparoscopic approach with antireflux surgery is superior to the thoracoscopic approach for the treatment of esophageal achalasia. Experience of a single surgical unit. Surg Endosc 16:1431–1437

    PubMed  Article  CAS  Google Scholar 

  3. Woltman TA, Pellegrini CA, Oelschlager BK (2005) Achalasia. Surg Clin North Am 85:483–493

    PubMed  Article  Google Scholar 

  4. Champault GG, Barrat C, Rozon RC, Rizk N, Catheline JM (1999) The effect of the learning curve on the outcome of laparoscopic treatment for gastroesophageal reflux. Surg Laparosc Endosc Percutan Tech 9:375–381

    PubMed  Article  CAS  Google Scholar 

  5. Deschamps C, Allen MS, Trastek VF, Johnson JO, Pairolero PC (1998) Early experience and learning curve associated with laparoscopic Nissen fundoplication. J Thorac Cardiovasc Surg 115:281–284

    PubMed  Article  CAS  Google Scholar 

  6. Gill J, Booth MI, Stratford J, Dehn TC (2007) The extended learning curve for laparoscopic fundoplication: a cohort analysis of 400 consecutive cases. J Gastrointest Surg 11:487–492

    PubMed  Article  CAS  Google Scholar 

  7. Watson DI, Baigrie RJ, Jamieson GG (1996) A learning curve for laparoscopic fundoplication. Definable, avoidable, or a waste of time? Ann Surg 224:198–203

    PubMed  Article  CAS  Google Scholar 

  8. Mitchell PC, Watson DI, Devitt PG, Britten-Jones R, MacDonald S, Myers JC, Jamieson GG (1995) Laparoscopic cardiomyotomy with a Dor patch for achalasia. Can J Surg 38:445–448

    PubMed  CAS  Google Scholar 

  9. Bonavina L (2006) Minimally invasive surgery for esophageal achalasia. World J Gastroenterol 12:5921–5925

    PubMed  Google Scholar 

  10. Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, Diener U, Eubanks TR, Way LW (1999) Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 230:587–593

    PubMed  Article  CAS  Google Scholar 

  11. Bloomston M, Serafini F, Boyce HW, Rosemurgy AS (2002) The “learning curve” in videoscopic Heller myotomy. JSLS 6:41–47

    PubMed  Google Scholar 

  12. Stewart KC, Finley RJ, Clifton JC, Graham AJ, Storseth C, Inculet R (1999) Thoracoscopic versus laparoscopic modified Heller Myotomy for achalasia: efficacy and safety in 87 patients. J Am Coll Surg 189:164–169

    PubMed  Article  CAS  Google Scholar 

  13. Hunt DR, Wills VL (2000) Laparoscopic Heller myotomy for achalasia. Aust N Z J Surg 70:582–586

    PubMed  Article  CAS  Google Scholar 

  14. Sharp KW, Khaitan L, Scholz S, Holzman MD, Richards WO (2002) 100 consecutive minimally invasive Heller myotomies: lessons learned. Ann Surg 235:631–638

    PubMed  Article  Google Scholar 

  15. Dagash H, Chowdhury M, Pierro A (2003) When can I be proficient in laparoscopic surgery? A systematic review of the evidence. J Pediatr Surg 38:720–724

    PubMed  Article  Google Scholar 

  16. Voitk AJ, Tsao SG, Ignatius S (2001) The tail of the learning curve for laparoscopic cholecystectomy. Am J Surg 182:250–253

    PubMed  Article  CAS  Google Scholar 

  17. Howard PJ, Maher L, Pryde A, Cameron EW, Heading RC (1992) Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh. Gut 33:1011–1015

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Surgery, Flinders Medical Centre, Flinders University, Room 3D211, Bedford Park, SA, 5042, Australia

    Brechtje A. Grotenhuis, Bas P. L. Wijnhoven, Justin R. Bessell & David I. Watson

  2. Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia

    Glyn G. Jamieson & Peter G. Devitt

Authors
  1. Brechtje A. Grotenhuis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bas P. L. Wijnhoven
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Glyn G. Jamieson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter G. Devitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Justin R. Bessell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David I. Watson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David I. Watson.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Grotenhuis, B.A., Wijnhoven, B.P.L., Jamieson, G.G. et al. Defining a Learning Curve for Laparoscopic Cardiomyotomy. World J Surg 32, 1689–1694 (2008). https://doi.org/10.1007/s00268-008-9622-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-008-9622-9

Keywords

  • Achalasia
  • Lower Esophageal Sphincter
  • Heller Myotomy
  • Laparoscopic Fundoplication
  • Postoperative Dysphagia