TY - JOUR
T1 - Implementation of laparoscopic colectomy with fast-track care in an academic medical center
T2 - benefits of a fully ascended learning curve and specialty expertise
AU - Bosio, Raul M.
AU - Smith, Bryan M.
AU - Aybar, Pablo Serrano
AU - Senagore, Anthony J.
PY - 2007/3
Y1 - 2007/3
N2 - 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.
AB - 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.
KW - Cost analysis
KW - Laparoscopic colectomy
KW - Length of stay
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U2 - 10.1016/j.amjsurg.2006.09.019
DO - 10.1016/j.amjsurg.2006.09.019
M3 - Article
C2 - 17320546
AN - SCOPUS:33847021350
SN - 0002-9610
VL - 193
SP - 413
EP - 416
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 3
ER -