title: Analysis of outcomes for single-incision laparoscopic surgery (SILS) right colectomy reveals a minimal learning curve.
abstract: BACKGROUND
  Single-incision right colectomy has emerged as a safe and feasible alternative to standard laparoscopic resection. As with any new surgical approach, definition of the number of procedures required to optimize the technique is an important goal. Data on this learning curve for single-incision right colectomy are lacking; therefore, we report the outcomes of consecutive single-incision right colectomies to identify the procedural learning curve.
  
  
  METHODS
  We retrospectively reviewed consecutive single-incision right colectomies performed by a single surgeon from May 2010 to May 2013. Patients were evaluated in groups of ten to minimize individual patient variability and selection bias. Demographics and peri-operative outcomes among groups were evaluated using ANOVA or Kruskal-Wallis. Statistical improvement was assessed between groups using Student T tests or Mann-Whitney U tests.
  
  
  RESULTS
  Seventy consecutive single-incision right colectomies were performed during the study period. There were no differences in patient demographics over the course of the experiences, suggesting that the selection bias did not influence the outcomes. There was a statistical improvement in operative time after the first 10 cases (103 vs. 130 min, p = 0.01). A second statistical improvement in operative time occurred after 40 cases (97 vs. 114 min, p = 0.03). There was no statistical improvement in estimated blood loss, lymph node harvest, conversion rate, length of stay, or post-operative morbidity throughout the experience.
  
  
  CONCLUSIONS
  Analysis of our large series of consecutive cases indicates that for a surgeon trained in advanced laparoscopic techniques and given adequate case volume, the outcomes from the procedure are quickly optimized with a minimal learning curve. Operative time is optimized following 40 procedures. Identification of the learning curve is critical for surgeons wishing to implement a single-incision approach and to ensure that the outcomes are optimized prior to thorough comparison with standard laparoscopic or open approaches.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, 5150 Centre Ave. Suite 420, Pittsburgh, PA, 15232, USA, kirkka@upmc.edu.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Kirk
authors.forename: Brian A
authors.initials: BA
authors.lastname: Boone
authors.forename: Leonard
authors.initials: L
authors.lastname: Evans
authors.forename: Steven
authors.initials: S
authors.lastname: Evans
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Holtzman
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome