title: Reaching proficiency in laparoscopic splenectomy.
abstract: 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.
authors.affiliation: Department of General Surgery, University of Baskent, Dadaloglu Mah., 01200, Serin Evler 39. Sk. No. 6 Yüregir/Adana, Turkey.
authors.forename: Tarik Zafer
authors.initials: TZ
authors.lastname: Nursal
authors.forename: Ali
authors.initials: A
authors.lastname: Ezer
authors.forename: Sedat
authors.initials: S
authors.lastname: Belli
authors.forename: Alper
authors.initials: A
authors.lastname: Parlakgumus
authors.forename: Kenan
authors.initials: K
authors.lastname: Caliskan
authors.forename: Turgut
authors.initials: T
authors.lastname: Noyan
mesh_terms: 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
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