title: Hand-assisted laparoscopic colectomy: the learning curve is for operative speed, not for quality.
abstract: OBJECTIVE
  We aimed to define the learning curve for hand-assisted laparoscopic colectomy (HALC).
  
  
  METHODS
  A retrospective analysis of prospectively recorded data was performed. Consecutive segmental and total HALC performed by a single surgeon with no prior HALC experience was included. Operative time and quality-related outcomes, including conversions, operative and postoperative complications, length of stay, reoperations and readmissions were compared for consecutive cohorts of 25 HALC. A subgroup analysis of right, left, total and proctocolectomy performed in each cohort of 25 HALC was also performed.
  
  
  RESULTS
  From December 2005 to February 2009, 200 HALC were performed. When evaluated in cohorts of 25 consecutive cases, operative times (155-206 min), operative complications (4-12%), postoperative complications (8-36%), length of stay (4-5 days), reoperations (0-8%) and readmissions (0-16%) were similar. In the subgroup analysis, there were no changes in the quality-related measures for any colectomy type or the operative time for right and proctocolectomy as experience was gained. Operative time decreased for left (183-127 min) and total HALC (259-218 min) after experience with 50 cases (P < 0.05).
  
  
  CONCLUSIONS
  HALC operative times decreased with surgeon experience. For quality-related outcomes, there was no learning curve for HALC.
authors.affiliation: Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: E
authors.initials: E
authors.lastname: Ozturk
authors.forename: A
authors.initials: A
authors.lastname: da Luz Moreira
authors.forename: J D
authors.initials: JD
authors.lastname: Vogel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002983:Clinical Competence; D003082:Colectomy / Q000379:methods*; D005260:Female; D058733:Hand-Assisted Laparoscopy; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications; D019984:Quality Indicators, Health Care; D012086:Reoperation; D012189:Retrospective Studies; D013996:Time and Motion Studies; D055815:Young Adult