The learning curve for hand-assisted laparoscopic colectomy: a single surgeon's experience.
BACKGROUND
Surgical experience and outcomes for hand-assisted laparoscopic colectomy were evaluated to define a learning curve.


METHODS
This study included 60 patients who underwent hand-assisted laparoscopic colectomies performed by a single surgeon. They were analyzed as three consecutive equal groups: A, B, and C. Pearson's chi-square test and one-way analysis of variance (ANOVA) were used to compare differences in demographics and perioperative parameters. Operative times were analyzed to document the learning curve for the procedure.


RESULTS
There were no significant differences between the three groups in terms of age, sex, operative procedure, or comorbidity. Groups B and C showed significantly shorter operative times, significantly earlier recoveries of gastrointestinal function, less blood loss, and shorter hospital stays than group A. The incidence of operative complications was not significantly different among the three groups (35% vs 5% vs 15%; p = 0.07).


CONCLUSIONS
Approximately 21 to 25 cases were needed to achieve proficiency in this series.
Kang
J-C
JC
Division of Colorectal Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC. jckang@ms22.hinet.net
Jao
S-W
SW
Chung
M-H
MH
Feng
C-C
CC
Chang
Y-J
YJ
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003082:Colectomy / Q000295:instrumentation / Q000379:methods*; D003108:Colonic Diseases / Q000473:pathology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery; D020685:Colonoscopes; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007858:Learning; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D011446:Prospective Studies; D016896:Treatment Outcome