Impact of Experience on Quality Outcomes in Single-incision Cholecystectomy in Children.
Single-incision laparoscopic cholecystectomy (SILC) has been shown to be safe in children; however, factors that impact outcomes are not well understood. We report a retrospective review of 151 patients who underwent SILC between 2009 and 2013. Regression analysis was used to determine inflection of learning curve. Patients were grouped by early cases, late cases, and late case with surgical trainees. Mean age for all patients was 15 ± 3 years (5-20.5 year), and mean weight was 66.5 ± 21.3 kg (15-117 kg). There was a decrease in operative times between the early group (n = 15) and the late group (n = 100) (75.3 vs 56.1 minutes, P < 0.05). Surgical trainees were involved in 36 cases, and their introduction did not significantly increase operative times (56.1 vs 60.4 minutes, P = NS (Non-significant)). No difference in operative times between early cases and cases with trainees was identified (75.3 vs 60.4 minutes, P = NS). The complication was 6 per cent, with no significant differences between the groups. There were five conversions (3.3%). During the adoption of SILC, significantly decreased operative times were achieved after a short learning curve, and these were maintained with surgical trainees. Our results show that SILC can be safely introduced into a pediatric surgical practice.
Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, Florida, USA.
Sandra M
SM
Farach
Paul D
PD
Danielson
Ernest K
EK
Amankwah
Nicole M
NM
Chandler
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017081:Cholecystectomy, Laparoscopic / Q000193:education / Q000379:methods* / Q000592:standards; D004502:Education, Medical, Continuing; D005260:Female; D005431:Florida; D006801:Humans; D059032:Learning Curve; D008297:Male; D061646:Operative Time; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult