Learning curves have been described for a variety of laparoscopic procedures including cholecystectomy, tubal ligation, and diagnostic laparoscopy. Although multiple series of laparoscopic colectomies have appeared, there is little information regarding the learning curve associated with this advanced procedure. The purpose of this study is to present a single team's experience with laparoscopic colon resection to allow the description of our learning curve. The data collected included age, sex, operating room time, recovery of bowel function, days to clear liquid, hospital stay, conversion, complications, indication for operation, and site of resection. Sixty consecutive patients were analyzed and divided into three groups: First 20, Second 20, and Third 20. There were no significant differences between the three groups with respect to age, male versus female ratio, indications for surgery, or site of resection. However, the complexity of surgical procedures and the incidence of previous major abdominal surgery increased steadily with experience. The incidence of pulmonary complications was 30 per cent in the First 20 group and decreased to 5 per cent for the next two groups. The conversion rate was 20 per cent for the First 20 group, 45 per cent for the Second 20 group, and decreased to 10 per cent for the Third 20 group. Time to first oral intake (3.9±2.4, 3.3±1.7, 1.6±0.9 P < 0.05 Student's t test) and length of stay (6.8±3.3, 6.6±2.8, 4.2±1.1) steadily decreased over time. Operating room costs increased from $3,003±$628 for the First twenty went to $4,215±$1,930 for the Third twenty; however, overall hospital costs steadily decreased ($13965±$6235, $14063±$3367 $11860±$2679). In conclusion, we have demonstrated that the learning curve for colonic resection occurs incrementally from the successful mastery of uncomplicated resections in good risk patients with no prior surgery to increasingly complex surgical resections.
|Original language||English (US)|
|Number of pages||5|
|State||Published - Jan 1 1995|
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