title: Single-incision laparoscopic cholecystectomy: a combined analysis of resident and attending learning curves at a single institution.
abstract: Single-incision laparoscopic cholecystectomy (SILC) is a recent technical modification on standard laparoscopic cholecystectomy that has been shown to be safe and feasible. Recent studies suggest that experienced laparoscopic surgeons have a short learning curve to become proficient  in SILC. However, little is known about the interaction of the learning curves of residents and attending surgeons at academic programs. We prospectively evaluated various metrics of both attending and resident surgeons as they progressed in their experience with SILC. Patients were placed  into cohorts of 25 based on teaching surgeon experience. Data recorded included patient-specific and operative variables along with complications, conversion to standard laparoscopic cholecystectomy, and outcomes. One hundred one patients underwent SILC. Twelve per cent of patients required  conversion to standard laparoscopic cholecystectomy. No significant difference was found in operative times compared within the experience-based cohorts (P = 0.21). A reduction in operative time was shown in residents who were proficient in standard laparoscopic cholecystectomy (SLC)  along their learning curve. Operative times remained the same for the teaching surgeon regardless of experience of resident surgeon. SILC has a short learning curve for resident surgeons who are proficient in standard laparoscopic surgery. SILC can be effectively taught with few complications  and outcomes similar to SLC with preservation of operative efficiency and safety. Further studies are warranted, however, at a national/international level to define the place and use for SILC as well as the incorporation of single-incision techniques into resident curriculum.
authors.affiliation: Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. mjoseph@unch.unc.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Joseph
authors.forename: Michael
authors.initials: M
authors.lastname: Phillips
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Rupp
mesh_terms: D000704:Analysis of Variance; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D059032:Learning Curve; D008297:Male; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome