title: Effects of surgical laparoscopic experience on the short-term postoperative outcome of rectal cancer: results of a high volume single center institution.
abstract: OBJECTIVE
  The purpose of the study was to assess the effects of the surgeon's learning curve on the short-term outcome of laparoscopic resections performed for rectal cancer.
  
  
  METHODS
  A total of 284 patients who underwent laparoscopic resection for rectal cancer performed by 3 different surgical teams between 2005 and 2008 were included in the study. The operative experience was represented by the team's previous surgical case numbers (frequency). Four skill levels were categorized as follows: Level 1: the first 60 cases, Level 2: 61 to 120 cases, Level 3: 121 to 180 cases, and Level 4:>180 cases. Characteristics of the patients, perioperative variables, and the experience levels of the surgeons were analyzed and compared. To investigate the learning curve, we used the following parameters: duration of operative time, conversion rates, general complications, anastomotic leak rates, and oncologic parameters.
  
  
  RESULTS
  Operative time gradually decreased with increasing experience. The mean operative times for Level 1, Level 2, and Level 3 were 195.0+/-46.7, 181.7+/-34.2, and 172.3+/-33.0 minutes, respectively, whereas the mean operative time for Level 4 was 151.3+/-27.7 minutes (P<0.05). With increased experience, conversion rates, complication rates, anastomotic leak rates, and hospitalization durations decreased (P<0.05). The resected specimen length was found to be longer with increased surgical experience (P<0.05). There were no significant differences among the groups with regard to tumor size, T stage, harvested lymph node count, lateral margin involvement, and R0 resections.
  
  
  CONCLUSIONS
  The operative time is inversely proportional to the level of skill. Laparoscopic surgical procedures do not have any negative effects on short-term surgical outcome. With the strict application of surgical principles, the oncologic quality of the specimen is not influenced by the experience period. With increased experience, the surgeon feels more confident and performs more difficult and complex laparoscopic surgical interventions for rectal cancer.
authors.affiliation: Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Balik
authors.forename: Oktar
authors.initials: O
authors.lastname: Asoglu
authors.forename: Sezer
authors.initials: S
authors.lastname: Saglam
authors.forename: Sumer
authors.initials: S
authors.lastname: Yamaner
authors.forename: Ali
authors.initials: A
authors.lastname: Akyuz
authors.forename: Yilmaz
authors.initials: Y
authors.lastname: Buyukuncu
authors.forename: Mine
authors.initials: M
authors.lastname: Gulluoglu
authors.forename: Turker
authors.initials: T
authors.lastname: Bulut
authors.forename: Dursun
authors.initials: D
authors.lastname: Bugra
mesh_terms: D002983:Clinical Competence; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting; D012004:Rectal Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016526:Workload