Transition from open to laparoscopic fundoplication: the learning curve

Area of Science:

• Surgical Education
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Laparoscopic fundoplication has been performed since 1992, with residents consistently serving as the primary surgeon.
• This study focuses on the learning curve associated with this complex surgical procedure.

Purpose of the Study:

• To evaluate the time and number of procedures required for both experienced surgeons and surgical residents to achieve proficiency in laparoscopic fundoplication.
• To identify key metrics for assessing surgical skill acquisition in this technique.

Main Methods:

• A retrospective review of 241 consecutive laparoscopic fundoplication cases performed between January 1992 and March 1998.
• Analysis of operative times, conversion rates, and intraoperative complication rates across different stages of surgical experience.
• Resident confidence assessed via questionnaires over a 3-year period.

Main Results:

• Initial learning curve shows a significant decrease in conversion rates (56% to 16%) and operative time (236 to 199 minutes) within the first 50 cases.
• Conversion rates stabilized at 2%, and operative times reduced to an average of 99 minutes for later cases.
• Residents reported feeling comfortable performing laparoscopic fundoplication after an average of 10.6 procedures, with prior experience in 15.7 laparoscopic fundoplications.

Conclusions:

• Experienced surgeons face a steep learning curve for the initial 25 laparoscopic fundoplications, with continued improvement observed beyond 100 cases.
• Surgical residents can attain proficiency and confidence in laparoscopic fundoplication after approximately 10-15 supervised procedures.
• Objective measures like operative time, conversion rates, and complication rates are crucial indicators of surgical learning.