title: Influence of the learning curve on safety and efficiency of laparoscopic sleeve gastrectomy.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric procedure, and data regarding the learning curve are scarce. The aim of this study is to assess how the procedure can be safely implanted in a newly established bariatric unit and to define the learning curve.
  
  
  METHODS
  Proctorship and mentorship in bariatric surgery were attended by two surgeons who were previously experienced in advanced laparoscopic surgery. The first consecutive 102 patients who underwent LSG in our newly established bariatric center were included. Patients were divided into three groups of 34 (groups 1, 2, and 3) according to case sequence. Data on demographics, operative time, conversion rate, hospital stay, morbidity, mortality, and excess weight loss (EWL) over time were compared between the groups.
  
  
  RESULTS
  The operative time was significantly lower in groups 2 (p = 0.016) and 3 (p = 0.003) compared to group 1. The learning curve was flat up to the 68th case. A significant decrease in hospital stay was noted for group 3 compared to groups 1 (p < 0.001) and 2 (p = 0.002). The conversion rate, mortality and morbidity rates, and EWL did not differ significantly between the groups. Mortality was 0.98% and procedure-related morbidity was 7.8%.
  
  
  CONCLUSIONS
  LSG can be safely and efficiently performed in a newly established bariatric center following a mentorship procedure. Proficiency seems to require 68 cases. The operative time and hospital stay may significantly decrease with experience early in the learning curve, as opposed to mortality and morbidity rates, conversion rate, and EWL.
authors.affiliation: Department of Surgery, University Hospital of Larissa, Larissa, 41110, Viopolis, Greece. zachadim@yahoo.com
authors.forename: Dimitris
authors.initials: D
authors.lastname: Zacharoulis
authors.forename: Eleni
authors.initials: E
authors.lastname: Sioka
authors.forename: Dimitris
authors.initials: D
authors.lastname: Papamargaritis
authors.forename: Olga
authors.initials: O
authors.lastname: Lazoura
authors.forename: Christos
authors.initials: C
authors.lastname: Rountas
authors.forename: Eleni
authors.initials: E
authors.lastname: Zachari
authors.forename: George
authors.initials: G
authors.lastname: Tzovaras
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002983:Clinical Competence; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D018579:Patient Selection; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult