Defining a learning curve for laparoscopic colorectal resections.
OBJECTIVE
The purpose of this review was to define the learning curve for laparoscopic colorectal resections.


METHODS
A prospectively accumulated, computerized database of all laparoscopic colorectal resections performed by three surgeons between April 1991 and March 1999 was reviewed.


RESULTS
A total of 461 consecutive resections were evenly distributed among three surgeons (141, 155, and 165). Median operating time was 180 minutes for Cases 1 to 30 in each surgeon's experience and declined to a steady state (150-167.5 minutes) for Cases 31 and higher. Subsequently, Cases 1 to 30 were considered "early experience," whereas Cases 31 and higher were combined as "late experience" for statistical analysis. There were no significant differences between patients undergoing resections in the early experience and those undergoing resections in the late experience with respect to age, weight, or proportion of patients with malignancy, diverticulitis, or inflammatory bowel disease. There were greater proportions of males (42 vs. 54 percent, P = 0.046) and rectal resections performed (14 vs. 32 percent, P = 0.002) in the late experience. Trends toward declining rates of intraoperative complications (9 vs. 7 percent, P = 0.70) and conversion to open surgery (13.5 vs. 9.7 percent, P = 0.39) were observed with experience. Median operating time (180 vs. 160 minutes, P < 0.001) and overall length of postoperative hospital stay (6.5 vs. 5 days, P < 0.001) declined significantly with experience. There was no difference in the rate of postoperative complications between early and late experience (30 vs. 32 percent, P = 0.827).


CONCLUSIONS
The learning curve for performing colorectal resections was approximately 30 procedures in this study, based on a decline in operating time, intraoperative complications, and conversion rate. Learning was also extended to clinical care because it was appreciated that patients could be discharged to their homes more quickly.
The University of Toronto Centre for Minimally Invasive Surgery, St. Michael's Hospital, Québec, Canada.
C M
CM
Schlachta
J
J
Mamazza
P A
PA
Seshadri
M
M
Cadeddu
R
R
Gregoire
E C
EC
Poulin
D002983:Clinical Competence; D003106:Colon / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000706:statistics & numerical data; D007858:Learning; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery; D013997:Time Factors