title: Laparoscopic colectomy: does the learning curve extend beyond colorectal surgery fellowship?
abstract: OBJECTIVE
  As minimally invasive colon and rectal resection has become increasingly prevalent over the past decade, the role that fellowship training plays has become an important question. This analysis examines the learning curve of one fellowship-trained colorectal surgeon in his first 100 cases.
  
  
  METHODS
  This was a prospectively collected retrospective analysis of the first 100 laparoscopic colon and rectal resections performed between July 2007 and July 2008 by a colorectal (CRS) fellowship trained surgeon at a Veteran's Administration (VA) and county hospital. Included were all emergent and nonemergent laparoscopic cases.
  
  
  RESULTS
  Mean age was 63(range, 36 to 91). The 100 resections included 42 right, 6 left, 32 sigmoid, 13 rectal, and 7 total abdominal colectomies. Indications were 55% cancer, 20% unresectable polyp, 18% diverticular, 4% inflammatory, and 3% other. Overall mortality was 3%. Overall morbidity including wound infection was 24%. Early and late groups were similar in age, ASA score, and indication. Conversion rate was 4%. No statistical difference was seen in mortality, morbidity, EBL, LOS, margin, lymph nodes, or conversions between the first and second 50 cases (P<0.05). Right and sigmoid colectomy operative time decreased by 40.0% and 19.6%, respectively.
  
  
  CONCLUSIONS
  Prior investigators have demonstrated a significant learning curve for laparoscopic colorectal surgery. In the first 100 cases, there is no difference in mortality or morbidity between early and late cases. Alternatively, operative times decreased with experience. Laparoscopic training during CRS fellowship surpasses the learning curve in regard to safety and outcome, whereas operative efficiency improves over the first year of practice.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Waters
authors.forename: Ray
authors.initials: R
authors.lastname: Chihara
authors.forename: Jose
authors.initials: J
authors.lastname: Moreno
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Robb
authors.forename: Eric A
authors.initials: EA
authors.lastname: Wiebke
authors.forename: Virgilio V
authors.initials: VV
authors.lastname: George
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003082:Colectomy / Q000193:education* / Q000379:methods; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies