title: Laparoscopic colorectal surgery in learning curve: Role of implementation of a standardized technique and recovery protocol. A cohort study.
abstract: BACKGROUND
  Despite the proven benefits, laparoscopic colorectal surgery is still under utilized among surgeons. A steep learning is one of the causes of its limited adoption. Aim of the study is to determine the feasibility and morbidity rate after laparoscopic colorectal surgery in a single institution, "learning curve" experience, implementing a well standardized operative technique and recovery protocol.
  
  
  METHODS
  The first 50 patients treated laparoscopically were included. All the procedures were performed by a trainee surgeon, supervised by a consultant surgeon, according to the principle of complete mesocolic excision with central vascular ligation or TME. Patients underwent a fast track recovery programme. Recovery parameters, short-term outcomes, morbidity and mortality have been assessed.
  
  
  RESULTS
  Type of resections: 20 left side resections, 8 right side resections, 14 low anterior resection/TME, 5 total colectomy and IRA, 3 total panproctocolectomy and pouch. Mean operative time: 227 min; mean number of lymph-nodes: 18.7. Conversion rate: 8%. Mean time to flatus: 1.3 days; Mean time to solid stool: 2.3 days. Mean length of hospital stay: 7.2 days. Overall morbidity: 24%; major morbidity (Dindo-Clavien III): 4%. No anastomotic leak, no mortality, no 30-days readmission.
  
  
  CONCLUSIONS
  Proper laparoscopic colorectal surgery is safe and leads to excellent results in terms of recovery and short term outcomes, even in a learning curve setting. Key factors for better outcomes and shortening the learning curve seem to be the adoption of a standardized technique and training model along with the strict supervision of an expert colorectal surgeon.
authors: Department of Clinical Medicine and Surgery, School of Medicine-Surgical Coloproctology Unit, University of Naples Federico II, Naples, Italy.
authors: Gaetano
authors: G
authors: Luglio
authors: Department of Clinical Medicine and Surgery, School of Medicine-Surgical Coloproctology Unit, University of Naples Federico II, Naples, Italy ; Center of Excellence for Technical Innovation in Surgery (CEITC), Italy.
authors: Giovanni Domenico
authors: GD
authors: De Palma
authors: Department of Clinical Medicine and Surgery, School of Medicine-Surgical Coloproctology Unit, University of Naples Federico II, Naples, Italy.
authors: Rachele
authors: R
authors: Tarquini
authors: Department of Clinical Medicine and Surgery, School of Medicine-Surgical Coloproctology Unit, University of Naples Federico II, Naples, Italy.
authors: Mariano Cesare
authors: MC
authors: Giglio
authors: Department of Clinical Medicine and Surgery, School of Medicine-Surgical Coloproctology Unit, University of Naples Federico II, Naples, Italy.
authors: Viviana
authors: V
authors: Sollazzo
authors: Department of Clinical Medicine and Surgery, School of Medicine-Surgical Coloproctology Unit, University of Naples Federico II, Naples, Italy.
authors: Emanuela
authors: E
authors: Esposito
authors: Department of Clinical Medicine and Surgery, School of Medicine-Surgical Coloproctology Unit, University of Naples Federico II, Naples, Italy.
authors: Emanuela
authors: E
authors: Spadarella
authors: Department of Clinical Medicine and Surgery, School of Medicine-Surgical Coloproctology Unit, University of Naples Federico II, Naples, Italy.
authors: Roberto
authors: R
authors: Peltrini
authors: Department of Clinical Medicine and Surgery, School of Medicine-Surgical Coloproctology Unit, University of Naples Federico II, Naples, Italy.
authors: Filomena
authors: F
authors: Liccardo
authors: Department of Clinical Medicine and Surgery, School of Medicine-Surgical Coloproctology Unit, University of Naples Federico II, Naples, Italy.
authors: Luigi
authors: L
authors: Bucci
keywords: Colorectal cancer; Enhanced recovery programme; Laparoscopic colorectal surgery; Laparoscopy; Learning curve