title: Defining the learning curve for laparoscopic splenectomy for immune thrombocytopenia purpura.
abstract: BACKGROUND
  The current study was undertaken to define the learning curve for laparoscopic splenectomy (LS) in patients with immune thrombocytopenic purpura (ITP).
  
  
  METHODS
  The data of 50 patients who underwent LS for ITP between March 1996 and February 2003 were reviewed. Patients were divided into sequential groups of 10. Operative time, estimated blood loss, conversion to open procedure, length of stay (LOS), time to oral intake, complications, and mortality rates were analyzed.
  
  
  RESULTS
  The mean OR time in the 3rd, 4th, and 5th groups of 10 were significantly shorter than the 1st and 2nd groups of 10. There were no significant differences in estimated blood loss, LOS, or time to oral intake between the groups. Three conversions to open splenectomy occurred; one each in the 2nd, 3rd, and 4th groups of 10. Complications were evenly distributed between groups. There were no deaths.
  
  
  CONCLUSIONS
  The learning curve for LS in patients with ITP is a minimum of 20 cases.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, The Methodist Hospital, Michael E. DeBakey VA Medical Center, 6550 Fannin, Suite 1661, Houston, TX 77030, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Peters
authors.forename: Diego
authors.initials: D
authors.lastname: Camacho
authors.forename: Herminio
authors.initials: H
authors.lastname: Ojeda
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Reichenbach
authors.forename: Eric M
authors.initials: EM
authors.lastname: Knauer
authors.forename: Alan M
authors.initials: AM
authors.lastname: Yahanda
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Cooper
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D011696:Purpura, Thrombocytopenic / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D013156:Splenectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome