Learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy.
OBJECTIVE
To investigate the learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy (SILC).


METHODS
The clinical data of 180 consecutive transumbilical suture-suspension SILCs performed by a team in our department during the period from August 2009 to March 2011 were retrospectively analyzed. Patients were divided into nine groups according to operation dates, and each group included 20 patients operated on consecutively in each time period. The surgical outcome was assessed by comparing operation time, blood loss during operation, and complications between groups in order to evaluate the improvement in technique.


RESULTS
A total of 180 SILCs were successfully performed by five doctors. The average operation time was 53.58 ± 30.08 min (range: 20.00-160.00 min) and average blood loss was 12.70 ± 11.60 mL (range: 0.00-100.00 mL). None of the patients were converted to laparotomy or multi-port laparoscopic cholecystectomy. There were no major complications such as hemorrhage or biliary system injury during surgery. Eight postoperative complications occurred mainly in the first three groups (n = 6), and included ecchymosis around the umbilical incision (n = 7) which resolved without special treatment, and one case of delayed bile leakage in group 8, which was treated by ultrasound-guided puncture and drainage. There were no differences in intraoperative blood loss, postoperative complications and length of postoperative hospital stay among the groups. Bonferroni's test showed that the operation time in group 1 was significantly longer than that in the other groups (F = 7.257, P = 0.000). The majority of patients in each group were discharged within 2 d, with an average postoperative hospital stay of 1.9 ± 1.2 d.


CONCLUSIONS
Following scientific principles and standard procedures, a team experienced in multi-port laparoscopic cholecystectomy can master the technique of SILC after 20 cases.
Second Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China.
Ming-Xin
MX
Pan
Zhi-Wei
ZW
Liang
Yuan
Y
Cheng
Ze-Sheng
ZS
Jiang
Xiao-Ping
XP
Xu
Kang-Hua
KH
Wang
Hai-Yan
HY
Liu
Yi
Y
Gao
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016063:Blood Loss, Surgical; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects; D013647:Task Performance and Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
Cholecystectomy; Learning curve; Single incision laparoscopic surgery; Suture-suspension