title: Laparoscopic colon resection early in the learning curve: what is the appropriate setting?
abstract: BACKGROUND
  Laparoscopic colon resection (LCR) is a safe and effective treatment of benign and malignant colonic lesions. There is little question that a steep learning curve exists for surgeons to become skilled and proficient at LCR. Because of this steep learning curve, debate exists regarding the appropriate hospital setting for LCR. We hypothesize that outcomes of LCR performed early in the learning curve at a regional medical center (New Hanover Regional Medical Center; NHRMC) and a university medical center (Baylor College of Medicine; BCM) would not be significantly different.
  
  
  METHODS
  The first 50 consecutive LCRs performed at each institution between August 2001 and December 2003 were reviewed. Age, mean body mass index (BMI), gender, history of previous abdominal surgery (PAS), operative approach [laparoscopic (LAP) versus hand/laparoscopic assisted (HAL)], conversions (Conv), operative time (OR time), pathology (benign vs. malignant), lymph nodes (LN) harvested in malignant cases, length of stay (LOS), morbidity and mortality were obtained. Continuous data were expressed as mean +/- SD. Data were analyzed by chi, Fisher exact test, or t test.
  
  
  RESULTS
  NHRMC patients were on average older females with a higher incidence of PAS. A LAP approach was more frequently performed at BCM (86%), whereas HAL was used more frequently at NHRMC (24%). Conversions to open were similar at both institutions (12%). Benign disease accounted for the majority of operations at both institutions. In cases of malignancy, more LN were harvested at BCM. OR time and LOS were shorter at NHRMC. Complication rates were similar between institutions. There were no anastomotic leaks or deaths.
  
  
  CONCLUSIONS
  LCR can be performed safely and with acceptable outcomes early in the learning curve at regional medical centers and university medical centers. Outcomes depend more on surgeons possessing advanced laparoscopic skills and adhering to accepted oncologic surgical principles in cases of malignancy, than on the size or location of the healthcare institution.
authors.affiliation: Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Reichenbach
authors.forename: A Darrel
authors.initials: AD
authors.lastname: Tackett
authors.forename: James
authors.initials: J
authors.lastname: Harris
authors.forename: Diego
authors.initials: D
authors.lastname: Camacho
authors.forename: Edward A
authors.initials: EA
authors.lastname: Graviss
authors.forename: Brendan
authors.initials: B
authors.lastname: Dewan
authors.forename: Ashley
authors.initials: A
authors.lastname: Vavra
authors.forename: Anquonette
authors.initials: A
authors.lastname: Stiles
authors.forename: William E
authors.initials: WE
authors.lastname: Fisher
authors.forename: F Charles
authors.initials: FC
authors.lastname: Brunicardi
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
mesh_terms: D002983:Clinical Competence; D003082:Colectomy / Q000193:education* / Q000379:methods*; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D012189:Retrospective Studies; D013781:Texas; D016896:Treatment Outcome