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Defining a learning curve for laparoscopic cardiomyotomy.

Brechtje A Grotenhuis1, Bas P L Wijnhoven, Glyn G Jamieson

  • 1Department of Surgery, Flinders Medical Centre, Flinders University, Room 3D211, Bedford Park, SA 5042, Australia.

World Journal of Surgery
|May 20, 2008
PubMed
Summary

A learning curve exists for laparoscopic cardiomyotomy in achalasia treatment, with outcomes similar for trainees and consultants after initial experience. Both institutional and individual surgeon experience impact procedure length and conversion rates.

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Medical Education

Background:

  • Achalasia is a rare esophageal motility disorder.
  • Laparoscopic cardiomyotomy is a standard surgical treatment for achalasia.
  • The existence of a learning curve for this procedure is debated.

Purpose of the Study:

  • To determine if a learning curve exists for laparoscopic cardiomyotomy in achalasia treatment.
  • To assess the impact of surgeon experience on operative outcomes.
  • To compare outcomes between consultant surgeons and surgical trainees.

Main Methods:

  • A prospective database of 186 patients undergoing laparoscopic cardiomyotomy for achalasia (1992-2006) was analyzed.
  • Operative and clinical outcomes were used to assess institutional and individual surgeon learning curves.

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  • Outcomes were compared between consultant surgeons and supervised trainees.

    • Main Results:

    • Procedure length decreased after the first 10 cases for both institutional and individual experience.
    • Conversion to open surgery was higher in the first 20 cases.
    • No significant differences in complications, satisfaction, reoperation, or dysphagia were found based on experience.
    • Trainees had longer operative times (93 vs. 79 minutes), but outcomes were comparable to consultants.

    Conclusions:

    • A defined institutional (20 cases) and individual (10 cases) learning curve exists for laparoscopic cardiomyotomy.
    • Clinical outcomes of laparoscopic cardiomyotomy are not significantly different between supervised trainees and consultant surgeons.