title: Competence acquisition for single-incision laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Within the past few years, there has been a push for an even more minimally invasive approach to biliary disease with the adoption of single-incision laparoscopic cholecystectomy. We sought to compare 4 individual surgeon experiences to define whether there exists a learning curve for performing single-incision laparoscopic cholecystectomy.
  
  
  METHODS
  We performed a retrospective review 290 single-incision laparoscopic cholecystectomies performed by a group of general surgeons, with varying levels of experience and training, at 3 institutions between May 2008 and September 2010. The procedure times were recorded for each single-incision laparoscopic cholecystectomy, ordered chronologically for each surgeon, and subsequently plotted on a graph. The patients were also combined into cohorts of 5 and 10 cases to further evaluate for signs of improvement in operative efficiency.
  
  
  RESULTS
  Of the 4 surgeons involved in the study, only 1 (surgeon 4, laparoscopic fellowship trained with <5 years' experience) confirmed the presence of a learning curve, reaching proficiency within the first 15 cases performed. The other surgeons had more variable procedure times, which did not show a distinct trend. When we evaluated the cases by cohorts of 5 cases, surgeon 4 had a significant difference between the first and last cohort. Increased body mass index resulted in a slightly longer operative time (P < .0063). The conversion rate to multiport laparoscopic surgery was 3.1%.
  
  
  CONCLUSIONS
  Our results indicate that among experienced general surgeons, there does not seem to be a significant learning curve when transitioning from conventional laparoscopic cholecystectomy to single-incision laparoscopic cholecystectomy. The least experienced surgeon in the group, surgeon 4, appeared to reach proficiency after 15 cases. Greater than 5 years of experience in laparoscopic surgery appears to provide surgeons with a sufficient skill set to obviate the need for a single-incision laparoscopic cholecystectomy learning curve.
authors.affiliation: Department of Surgery, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA.
authors.forename: Gary B
authors.initials: GB
authors.lastname: Deutsch
authors.affiliation: Department of Surgery, North Shore University Hospital, Hofstra-North Shore-LIJ Health System, Manhasset, NY, USA.
authors.forename: Sandeep Anantha
authors.initials: SA
authors.lastname: Sathyanarayana
authors.affiliation: Department of Surgery, North Shore University Hospital, Hofstra-North Shore-LIJ Health System, Manhasset, NY, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Giangola
authors.affiliation: Department of Biostatistics, Feinstein Institute for Medical Research, Manhasset, NY, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Akerman
authors.affiliation: Department of Surgery, St. Francis Hospital/Catholic Health System of Long Island, Roslyn, NY, USA.
authors.forename: George
authors.initials: G
authors.lastname: DeNoto
authors.affiliation: Department of Surgery, North Shore University Hospital, Hofstra-North Shore-LIJ Health System, Manhasset, NY, USA.
authors.forename: Jonathan D S
authors.initials: JD
authors.lastname: Klein
authors.affiliation: Westmed Medical Group, White Plains, NY, USA.
authors.forename: Harry
authors.initials: H
authors.lastname: Zemon
authors.affiliation: Department of Surgery, St. Francis Hospital/Catholic Health System of Long Island, Roslyn, NY, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Rubach
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic; D002983:Clinical Competence; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies
keywords: Education; Laparoscopic cholecystectomy; Learning curve; Proficiency; Single-incision laparoscopic surgery
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