An objective experimental assessment of the learning curve for laparoscopic surgery: the example of pelvic and para-aortic lymph node dissection.
OBJECTIVE
To date the number of procedures required to become competent to perform new laparoscopic surgical techniques is not known.


METHODS
The pig model was chosen for assessment of the learning curve associated with an advanced laparoscopic procedure. A unilateral laparoscopic pelvic lymphadenectomy was performed by two residents and a laparoscopic para-aortic lymphadenectomy was performed by a fellow on a series of 20 pigs. The quality of the dissection was checked by immediate laparotomy by an independent observer.


RESULTS
The operative objectives were: (a) There should be less than 5% residual lymph nodes. (b) The operating time should be less than 30 min for pelvic and less than 100 min for para-aortic lymphadenectomy. (c) Avoiding conversion because of complications. This target was achieved after 7 and 9 pigs respectively for pelvic lymphadenectomy and after 14 pigs for para-aortic lymphadenectomy.


CONCLUSIONS
It is feasible to assess the learning curve of trainee surgeons while performing laparoscopic pelvic and para-aortic lymphadenectomy on pigs. A training programme such as this should prevent complications due to inexperience and should satisfy ethical and medico-legal considerations.
Querleu
D
D
Département Hospitalo-Universitaire de Recherche Expérimentale, Faculté de Médecine, Lille, France. dquerleu@chru-lille.fr
Lanvin
D
D
Elhage
A
A
Henry-Buisson
B
B
Leblanc
E
E
D000818:Animals; D001011:Aorta; D004501:Education, Medical; D005260:Female; D013502:General Surgery / Q000193:education*; D010535:Laparoscopy; D007858:Learning; D008197:Lymph Node Excision / Q000379:methods*; D010388:Pelvis; D013552:Swine; D013997:Time Factors