title: Institution learning curve of laparoscopic colectomy--a multi-dimensional analysis.
abstract: BACKGROUND
  This study aimed to evaluate the learning curve for laparoscopic colorectal resection of a university colorectal unit, the operative outcome in its developing and established period of laparoscopic colorectal resection is compared.
  
  
  METHODS
  We analyzed 1,031 consecutive patients who underwent laparoscopic colorectal resections for colorectal carcinoma performed in a colorectal unit between April 1992 and December 2008. Multi-dimensional analyses of the learning curves of the institution and seven individual surgeons were performed.
  
  
  RESULTS
  The operative outcomes of period 2 (2002-2008) was generally better than period 1 (1992-2001), in terms of operative time, number of lymph nodes retrieved, intra-operative blood loss and transfusion. The conversion rate of period 1 was higher than period 2 (19.7% vs. 5.1%, p < 0.001). There were no difference in the rates of intra-operative complications (2% vs. 3.3%, p = 0.32) and major post-operative complications (6% vs. 4.5%, p = 0.28). Analysis of the operative time using moving average method showed that the operative time of period 2 was generally shorter than that of period 1. The operative time transiently increased when there were new trainee surgeons joining the program. The CUSUM analysis of institutional conversion rate showed a steady state being reached at 310 cases. For the rates of intra-operative and major post-operative complications, steady states were both achieved at around 50 cases, and these rates were maintained during the whole study period.
  
  
  CONCLUSIONS
  Operative outcome of laparoscopic colorectal resection improved with experience. Continuous training of new trainee would not affect the operative outcomes of an established specialized unit.
authors: Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. jimmylicm@hotmail.com
authors: Jimmy C M
authors: JC
authors: Li
authors: Anthony W I
authors: AW
authors: Lo
authors: Sophie S F
authors: SS
authors: Hon
authors: Simon S M
authors: SS
authors: Ng
authors: Janet F Y
authors: JF
authors: Lee
authors: Ka Lau
authors: KL
authors: Leung
mesh_terms: D000047:Academies and Institutes / Q000706:statistics & numerical data*; D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000193:education* / Q000706:statistics & numerical data*; D003710:Demography; D004501:Education, Medical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000193:education* / Q000706:statistics & numerical data*; D059032:Learning Curve; D008297:Male; D010820:Physicians / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome