Implementation of laparoscopic colectomy with fast-track care in an academic medical center: benefits of a fully ascended learning curve and specialty expertise

Raul M. Bosio, Bryan M. Smith, Pablo Serrano Aybar, Anthony J. Senagore

    Research output: Contribution to journalArticle

    32 Scopus citations

    Abstract

    Background: There are few data describing successful institutional "conversion" from open colectomy/standard care techniques to laparoscopic colectomy/fast-track care. Purpose: To assess the benefits of transitioning an institution from open to laparoscopic colectomy with fast-track care while avoiding a learning curve. Method: Twenty consecutive laparoscopic colorectal resections (LCRs) performed by a colorectal surgeon were compared with 20 matched open colorectal resections (OCRs) performed by general surgeons before the arrival of the colorectal surgeon. Results: Surgical procedures were as follows: sigmoidectomy: OCR 16 and LCR 11; right colectomy: OCR 3 and LCR 8; and total colectomy: OCR 1 and LCR 1. The mean operative time for sigmoidectomy was 250 and 109 minutes for OCR and LCR, respectively, and for right colectomy 181 and 97 minutes for OCR and LCR, respectively (P < .001). Morbidity was OCR 45% versus LCR 25%. There was no mortality. LCR showed significantly lower length of stay and direct cost (3.6 vs. 8.3 days; $4,993 vs. $11,383; both P < .001). Conclusions: The data clearly show an institutional benefit for the implementation of specialty-based advanced laparoscopic procedures.

    Original languageEnglish (US)
    Pages (from-to)413-416
    Number of pages4
    JournalAmerican Journal of Surgery
    Volume193
    Issue number3
    DOIs
    StatePublished - Mar 1 2007

    Keywords

    • Cost analysis
    • Laparoscopic colectomy
    • Length of stay

    ASJC Scopus subject areas

    • Surgery

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