Reaching proficiency in laparoscopic splenectomy.
OBJECTIVE
To investigate the proficiency level reached in laparoscopic splenectomy using the learning curve method.


METHODS
All patients in need of splenectomy for benign causes in whom laparoscopic splenectomy was attempted by a single surgeon during a time period of 6 years were included in the study (n = 33). Besides demographics, operation-related variables and the response to surgery were recorded. The patients were allocated to groups of five, ranked according to the date of the operation. Operation duration, complications, postoperative length of stay, conversion to laparotomy and splenic weight were then compared between these groups.


RESULTS
There was a significant difference regarding operation times between the groups (P = 0.001). An improvement was observed after the first 5 cases. The learning curve was flat up to the 25th case. Following the 25th case the operation times decreased still further. There was no difference between the groups regarding the other parameters.


CONCLUSIONS
Unlike the widely accepted "L" shape, the learning curve for laparoscopic splenectomy is a horizontal lazy "S" with two distinct slopes. Privileges may be granted after the first 5 cases. However proficiency seems to require 25 cases.
Nursal
Tarik Zafer
TZ
Department of General Surgery, University of Baskent, Dadaloglu Mah., 01200, Serin Evler 39. Sk. No. 6 Yüregir/Adana, Turkey.
Ezer
Ali
A
Belli
Sedat
S
Parlakgumus
Alper
A
Caliskan
Kenan
K
Noyan
Turgut
T
D000328:Adult; D002983:Clinical Competence; D004502:Education, Medical, Continuing; D005260:Female; D005762:Gastroenterology / Q000193:education* / Q000592:standards*; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000592:standards*; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013156:Splenectomy / Q000379:methods* / Q000592:standards*; D013514:Surgical Procedures, Operative; D013997:Time Factors; D016896:Treatment Outcome
Ann Surg. 2001 Feb;233(2):159-66
11176120
J Am Coll Surg. 2003 Oct;197(4):620-3
14522333
Surgery. 2003 Jul;134(1):45-52
12874582
Surg Endosc. 1992 Nov-Dec;6(6):305-8
1448752
J Surg Res. 1999 Jan;81(1):27-32
9889053
World J Gastroenterol. 2003 May;9(5):1086-9
12717862
J Pediatr Surg. 2001 Feb;36(2):309-11
11172422
Curr Surg. 2001 Jan;58(1):63-67
11226540
J Laparoendosc Adv Surg Tech A. 2000 Dec;10(6):319-23
11132911
Am J Surg. 2001 May;181(5):393-7
11448428
Surg Endosc. 2002 Jun;16(6):954-6
12163962
Am J Surg. 2004 Nov;188(5):522-5
15546563
J Pediatr Surg. 2003 May;38(5):720-4
12720179
Surg Endosc. 2006 Aug;20(8):1214-20
16823653
Surg Endosc. 2002 Feb;16(2):272-9
11967677
Ann Surg. 1998 Oct;228(4):568-78
9790346
Surg Endosc. 2002 May;16(5):851-4
11997836
ANZ J Surg. 2002 Jul;72(7):523-7
12123518
Surg Laparosc Endosc Percutan Tech. 2005 Jun;15(3):139-43
15956897