title: Implementation of laparoscopic colectomy with fast-track care in an academic medical center: benefits of a fully ascended learning curve and specialty expertise.
abstract: BACKGROUND
  There are few data describing successful institutional "conversion" from open colectomy/standard care techniques to laparoscopic colectomy/fast-track care.
  
  
  OBJECTIVE
  To assess the benefits of transitioning an institution from open to laparoscopic colectomy with fast-track care while avoiding a learning curve.
  
  
  METHODS
  Twenty consecutive laparoscopic colorectal resections (LCRs) performed by a colorectal surgeon were compared with 20 matched open colorectal resections (OCRs) performed by general surgeons before the arrival of the colorectal surgeon.
  
  
  RESULTS
  Surgical procedures were as follows: sigmoidectomy: OCR 16 and LCR 11; right colectomy: OCR 3 and LCR 8; and total colectomy: OCR 1 and LCR 1. The mean operative time for sigmoidectomy was 250 and 109 minutes for OCR and LCR, respectively, and for right colectomy 181 and 97 minutes for OCR and LCR, respectively (P < .001). Morbidity was OCR 45% versus LCR 25%. There was no mortality. LCR showed significantly lower length of stay and direct cost (3.6 vs. 8.3 days; 4,993 dollars vs. 11,383 dollars; both P < .001).
  
  
  CONCLUSIONS
  The data clearly show an institutional benefit for the implementation of specialty-based advanced laparoscopic procedures.
authors.affiliation: Department of Surgery, University of Toledo, 3065 Arlington Avenue, Dowling Hall, Toledo, OH 43614-5807, USA.
authors.forename: Raul M
authors.initials: RM
authors.lastname: Bosio
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Smith
authors.forename: Pablo Serrano
authors.initials: PS
authors.lastname: Aybar
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
mesh_terms: D000046:Academic Medical Centers; D003082:Colectomy / Q000191:economics / Q000193:education* / Q000379:methods*; D003107:Colorectal Surgery / Q000193:education* / Q000379:methods*; D003362:Cost-Benefit Analysis; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D009820:Ohio; D012086:Reoperation; D016896:Treatment Outcome