title: Medial-to-lateral laparoscopic colon resection: a view beyond the learning curve.
abstract: BACKGROUND
  Since the authors' report on the lateral approach to laparoscopic colon resection (LCR), medial-to-lateral (M-L) segmental resection has continued to evolve. This report analyzes their learning curve experience with a standardized three-trocar M-L technique, which demonstrates the influence of operative volume on proficiency and outcome.
  
  
  METHODS
  From January 1999 to December 2004, 100 consecutive patients underwent a standardized three-trocar M-L segmental LCR. Patient demographics, indications for surgery, operative proficiency (time), and outcome (i.e., blood loss, conversion to open surgery, length of hospital stay, morbidity, and mortality) were recorded. A learning curve analysis was performed using a t-test and analysis of variance (ANOVA).
  
  
  RESULTS
  The 100 M-L LCRs included sigmoid (55%), right (34%), left (6%), and transverse (5%) approaches. Overall learning curve proficiency was influenced by increasing operative experience (p = 0.02). However, significant and consistent improvement in the learning curve occurred only after 38 LCRs (p < 0.008). Notably, all conversions to open surgery (3%) occurred during the early learning curve. Similarly, early LCR patients experienced greater morbidity (mean, 21% vs 12%) and mortality (mean, 5% vs 2%) than their later counterparts.
  
  
  CONCLUSIONS
  To obtain optimum proficiency in performing LCR, a minimum of 38 M-L procedures is required. Operative and patient outcomes improve beyond the early learning curve.
authors.affiliation: Department of Surgery, Lutheran Medical Center, 150 55th Street, Brooklyn, New York 11220, United States. jkim@lmcmc.com
authors.forename: J
authors.initials: J
authors.lastname: Kim
authors.forename: E
authors.initials: E
authors.lastname: Edwards
authors.forename: W
authors.initials: W
authors.lastname: Bowne
authors.forename: A
authors.initials: A
authors.lastname: Castro
authors.forename: V
authors.initials: V
authors.lastname: Moon
authors.forename: P
authors.initials: P
authors.lastname: Gadangi
authors.forename: G
authors.initials: G
authors.lastname: Ferzli
mesh_terms: D016063:Blood Loss, Surgical; D003082:Colectomy / Q000193:education / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007858:Learning; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications