Laparoscopic colectomy

Does the learning curve extend beyond colorectal surgery fellowship?

Joshua A. Waters, Ray Chihara, Jose Moreno, Bruce Robb, Eric A. Wiebke, Virgilio V. George

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background and Objectives: As minimally invasive colon and rectal resection has become increasingly prevalent over the past decade, the role that fellowship training plays has become an important question. This analysis examines the learning curve of one fellowship-trained colorectal surgeon in his first 100 cases. Methods: This was a prospectively collected retrospective analysis of the first 100 laparoscopic colon and rectal resections performed between July 2007 and July 2008 by a colorectal (CRS) fellowship trained surgeon at a Veteran's Administration (VA) and county hospital. Included were all emergent and nonemergent laparoscopic cases. Results: Mean age was 63(range, 36 to 91). The 100 resections included 42 right, 6 left, 32 sigmoid, 13 rectal, and 7 total abdominal colectomies. Indications were 55% cancer, 20% unresectable polyp, 18% diverticular, 4% inflammatory, and 3% other. Overall mortality was 3%. Overall morbidity including wound infection was 24%. Early and late groups were similar in age, ASA score, and indication. Conversion rate was 4%. No statistical difference was seen in mortality, morbidity, EBL, LOS, margin, lymph nodes, or conversions between the first and second 50 cases (P<0.05). Right and sigmoid colectomy operative time decreased by 40.0% and 19.6%, respectively. Conclusion: Prior investigators have demonstrated a significant learning curve for laparoscopic colorectal surgery. In the first 100 cases, there is no difference in mortality or morbidity between early and late cases. Alternatively, operative times decreased with experience. Laparoscopic training during CRS fellowship surpasses the learning curve in regard to safety and outcome, whereas operative efficiency improves over the first year of practice.

Original languageEnglish
Pages (from-to)325-331
Number of pages7
JournalJSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Volume14
Issue number3
DOIs
StatePublished - Jul 2010

Fingerprint

Colorectal Surgery
Learning Curve
Colectomy
Sigmoid Colon
Operative Time
Morbidity
Mortality
Colon
Veterans Hospitals
County Hospitals
United States Department of Veterans Affairs
Wound Infection
Polyps
Laparoscopy
Lymph Nodes
Research Personnel
Efficiency
Safety
Neoplasms
Surgeons

Keywords

  • Colectomy
  • Colon cancer
  • Laparoscopy
  • Learning curve

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic colectomy : Does the learning curve extend beyond colorectal surgery fellowship? / Waters, Joshua A.; Chihara, Ray; Moreno, Jose; Robb, Bruce; Wiebke, Eric A.; George, Virgilio V.

In: JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons, Vol. 14, No. 3, 07.2010, p. 325-331.

Research output: Contribution to journalArticle

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abstract = "Background and Objectives: As minimally invasive colon and rectal resection has become increasingly prevalent over the past decade, the role that fellowship training plays has become an important question. This analysis examines the learning curve of one fellowship-trained colorectal surgeon in his first 100 cases. Methods: This was a prospectively collected retrospective analysis of the first 100 laparoscopic colon and rectal resections performed between July 2007 and July 2008 by a colorectal (CRS) fellowship trained surgeon at a Veteran's Administration (VA) and county hospital. Included were all emergent and nonemergent laparoscopic cases. Results: Mean age was 63(range, 36 to 91). The 100 resections included 42 right, 6 left, 32 sigmoid, 13 rectal, and 7 total abdominal colectomies. Indications were 55{\%} cancer, 20{\%} unresectable polyp, 18{\%} diverticular, 4{\%} inflammatory, and 3{\%} other. Overall mortality was 3{\%}. Overall morbidity including wound infection was 24{\%}. Early and late groups were similar in age, ASA score, and indication. Conversion rate was 4{\%}. No statistical difference was seen in mortality, morbidity, EBL, LOS, margin, lymph nodes, or conversions between the first and second 50 cases (P<0.05). Right and sigmoid colectomy operative time decreased by 40.0{\%} and 19.6{\%}, respectively. Conclusion: Prior investigators have demonstrated a significant learning curve for laparoscopic colorectal surgery. In the first 100 cases, there is no difference in mortality or morbidity between early and late cases. Alternatively, operative times decreased with experience. Laparoscopic training during CRS fellowship surpasses the learning curve in regard to safety and outcome, whereas operative efficiency improves over the first year of practice.",
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