title: The learning curve of laparoendoscopic single-site (LESS) cholecystectomy: definable, short, and safe.
abstract: BACKGROUND
  The applications of laparoendoscopic single-site (LESS) surgery, including cholecystectomy, are occurring quickly, although little is generally known about issues associated with the learning curve of this new technique including operative time, conversion rates, and safety.
  
  
  METHODS
  We prospectively followed all patients undergoing LESS cholecystectomy, and compared operations undertaken at our institutions in cohorts of 25 patients with respect to operative times, conversion rates, and complications.
  
  
  RESULTS
  One-hundred fifty patients of mean age 46 years underwent LESS cholecystectomy. No significant differences in operative times were demonstrable between any of the 25-patient cohorts operated on at our institution. A significant reduction in operative times (p < 0.001) after completion of 75 LESS procedures was, however, identified with the experience of a single surgeon. No significant reduction in the number of procedures requiring an additional trocar(s) or conversion to open operations was observed after completion of 25 LESS cholecystectomies. Complication rates were low, and not significantly different between any 25-patient cohorts.
  
  
  CONCLUSIONS
  For surgeons proficient with multi-incision laparoscopic cholecystectomy, the learning curve for LESS cholecystectomy begins near proficiency. Operative complications and conversions were infrequent and unchanged across successive 25-patient cohorts, and were similar to those reported for multi-incision laparoscopic cholecystectomy after the learning curve.
authors.affiliation: Department of Surgery, University of South Florida College of Medicine, Tampa General Hospital, Tampa, FL 33601, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hernandez
authors.forename: Sharona
authors.initials: S
authors.lastname: Ross
authors.forename: Connor
authors.initials: C
authors.lastname: Morton
authors.forename: Kellie
authors.initials: K
authors.lastname: McFarlin
authors.forename: Sujat
authors.initials: S
authors.lastname: Dahal
authors.forename: Farhaad
authors.initials: F
authors.lastname: Golkar
authors.forename: Michael
authors.initials: M
authors.lastname: Albrink
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosemurgy
mesh_terms: D000208:Acute Disease; D001659:Biliary Tract / Q000293:injuries; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000193:education* / Q000379:methods / Q000706:statistics & numerical data*; D002908:Chronic Disease; D015331:Cohort Studies; D004890:Erythema / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology