title: Early learning effect of residents for laparoscopic sigmoid resection.
abstract: OBJECTIVE
  To evaluate the effect of learning the laparoscopic sigmoid resection procedure on resident surgeons; establish a minimum number of cases before a resident surgeon could be expected to achieve proficiency with the procedure; and examine if an analysis could be used to measure and support the clinical evaluation of the surgeon's competence with the procedure.
  
  
  METHODS
  Retrospective analysis of data which was prospective entered in the database.
  
  
  METHODS
  From 2003 to 2007 all patients who underwent a laparoscopic sigmoid resection carried out by senior residents, who completed the procedure as the primary surgeon proctored by an experienced surgeon, were included in the study. A cumulative sum control chart (CUSUM) analysis was used evaluate performance. The procedure was defined as a failure if major intra-operative complications occurred such as intra abdominal organ injury, bleeding, or anastomotic leakage; if an inadequate number of lymph nodes (<12 nodes) were removed; or if conversion to an open surgical procedure was required.
  
  
  RESULTS
  Thirteen residents performed 169 laparoscopic sigmoid resections in the period evaluated. A significant majority of the resident surgeons were able to consistently perform the procedure without failure after 11 cases and determined to be competent. One resident was not determined to be competent and the CUSUM score supported these findings.
  
  
  CONCLUSIONS
  We concluded that at least 11 cases are required for most residents to obtain necessary competence with the laparoscopic sigmoid resection procedure. Evaluation with the CUSUM analysis can be used to measure and support the clinical evaluation of the resident surgeon's competence with the procedure.
authors: Department of Surgery, Deventer Hospital, 7400 GC Deventer, The Netherlands. r.bosker@kpnmail.nl
authors: Robbert
authors: R
authors: Bosker
authors: Henk
authors: H
authors: Groen
authors: Christiaan
authors: C
authors: Hoff
authors: Eric
authors: E
authors: Totte
authors: Rutger
authors: R
authors: Ploeg
authors: Jean-Pierre
authors: JP
authors: Pierie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D012809:Colon, Sigmoid / Q000601:surgery*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies