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Hand-assisted laparoscopic colectomy: the learning curve is for operative speed, not for quality
E Ozturk1, A da Luz Moreira, J D Vogel
1Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Aim:
We aimed to define the learning curve for hand-assisted laparoscopic colectomy (HALC).
Method:
A retrospective analysis of prospectively recorded data was performed. Consecutive segmental and total HALC performed by a single surgeon with no prior HALC experience was included. Operative time and quality-related outcomes, including conversions, operative and postoperative complications, length of stay, reoperations and readmissions were compared for consecutive cohorts of 25 HALC. A subgroup analysis of right, left, total and proctocolectomy performed in each cohort of 25 HALC was also performed.
Results:
From December 2005 to February 2009, 200 HALC were performed. When evaluated in cohorts of 25 consecutive cases, operative times (155-206 min), operative complications (4-12%), postoperative complications (8-36%), length of stay (4-5 days), reoperations (0-8%) and readmissions (0-16%) were similar. In the subgroup analysis, there were no changes in the quality-related measures for any colectomy type or the operative time for right and proctocolectomy as experience was gained. Operative time decreased for left (183-127 min) and total HALC (259-218 min) after experience with 50 cases (P < 0.05).
Conclusion:
HALC operative times decreased with surgeon experience. For quality-related outcomes, there was no learning curve for HALC.
