title: The learning curve of laparoendoscopic single-Site (LESS) fundoplication: definable, short, and safe.
abstract: OBJECTIVE
  This study of laparoendoscopic single-site (LESS) fundoplication for gastroesophageal reflux disease was undertaken to determine the "learning curve" for implementing LESS fundoplication.
  
  
  METHODS
  One hundred patients, 38% men, with a median age of 61 years and median body mass index of 26 kg/m(2) , underwent LESS fundoplications. The operative times, placement of additional trocars, conversions to "open" operations, and complications were compared among patient quartiles to establish a learning curve. Median data are reported.
  
  
  RESULTS
  The median operative times and complications did not differ among 25-patient cohorts. Additional trocars were placed in 27% of patients, 67% of whom were in the first 25-patient cohort. Patients undergoing LESS fundoplication had a dramatic relief in the frequency and severity of all symptoms of reflux across all cohorts equally (P < .05), particularly for heartburn and regurgitation, without causing dysphagia.
  
  
  CONCLUSIONS
  LESS fundoplication ameliorates symptoms of gastroesophageal reflux disease without apparent scarring. Notably, few operations required additional trocars after the first 25-patient cohort. Patient selection became more inclusive (eg, more "redo" fundoplications) with increasing experience, whereas operative times and complications remained relatively unchanged. The learning curve of LESS fundoplication is definable, short, and safe. We believe that patients will seek LESS fundoplication because of the efficacy and superior cosmetic outcomes; surgeons will need to meet this demand.
authors.affiliation: Florida Hospital Tampa, 3000 Medical Park Dr, Ste 310, Tampa, FL 33613, USA. sharona.ross@yahoo.com.
authors.forename: Sharona B
authors.initials: SB
authors.lastname: Ross
authors.forename: Edward
authors.initials: E
authors.lastname: Choung
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Teta
authors.forename: Lotiffa
authors.initials: L
authors.lastname: Colibao
authors.forename: Kenneth
authors.initials: K
authors.lastname: Luberice
authors.forename: Harold
authors.initials: H
authors.lastname: Paul
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
mesh_terms: D015992:Body Mass Index; D050782:Esophageal pH Monitoring; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
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