title: Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is lengthy--analysis of learning curves for a novice minimally invasive surgeon.
abstract: BACKGROUND
  Associated with reduced trauma, laparoscopic colon surgery is an alternative to open surgery. Furthermore, complete mesocolic excision (CME) has been shown to provide superior nodal yield and offers the prospect of better oncological outcomes.
  
  
  METHODS
  All oncologic laparoscopic right colon resections with CME performed by a single surgeon since the beginning of his surgical practice were retrospectively analyzed for operative duration and perioperative outcomes.
  
  
  RESULTS
  The study included 81 patients. The average duration of surgery was 220.0 (range 206-233) minutes. The initial durations of about 250 minutes gradually decreased to less than 200 minutes in an inverse linear relationship (y = -0.58x × 248). The major complication rate was 3.6% ± 4.2% and the average nodal yield was 31.3 ± 4.1. CumulativeSum analysis showed acceptable complication rates and oncological results from the beginning of surgeon's laparoscopic career.
  
  
  CONCLUSIONS
  Developing laparoscopic skills can provide acceptable outcomes in advanced right hemicolectomy for a surgeon who primarily trained in open colorectal surgery. Operative duration is nearly triple that reported for conventional laparoscopic right hemicolectomy. The slow operative duration learning curve without a plateau reflects complex anatomy and the need for careful dissection around critical structures. Should one wish to adopt this strategy either based on some available evidence of superiority or with intention to participate in research, one has to change the view of right hemicolectomy being a rather simple case to being a complex, lengthy laparoscopic surgery.
authors.affiliation: The Jewish General Hospital, McGill University, Montréal, Que..
authors.forename: George
authors.initials: G
authors.lastname: Melich
authors.affiliation: The Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Duck Hyoun
authors.initials: DH
authors.lastname: Jeong
authors.affiliation: The Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hyuk
authors.initials: H
authors.lastname: Hur
authors.affiliation: The Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Baik
authors.affiliation: The Jewish General Hospital, McGill University, Montréal, Que..
authors.forename: Julio
authors.initials: J
authors.lastname: Faria
authors.affiliation: The Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
authors.affiliation: The Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea, and the Robot and Minimally Invasive Surgery Center, Yonsei University Health System, Seoul, South Koreaa.
authors.forename: Byung Soh
authors.initials: BS
authors.lastname: Min
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003082:Colectomy / Q000193:education* / Q000379:methods; D003110:Colonic Neoplasms / Q000601:surgery*; D004502:Education, Medical, Continuing / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D059032:Learning Curve; D008297:Male; D008646:Mesocolon / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000193:education / Q000379:methods; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome