Institution learning curve of laparoscopic colectomy--a multi-dimensional analysis

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Surgical Education

Background:

• Evaluating the learning curve for laparoscopic colorectal resection.
• Comparing operative outcomes during the developing and established phases of a university colorectal unit's laparoscopic colorectal resection program.

Purpose of the Study:

• To assess the learning curve and operative outcomes of laparoscopic colorectal resection.
• To compare outcomes between the early and later periods of implementation.

Main Methods:

• Analysis of 1,031 consecutive laparoscopic colorectal resections for carcinoma (1992-2008).
• Multi-dimensional learning curve analysis for the institution and seven individual surgeons.
• Comparison of operative outcomes between two distinct time periods (1992-2001 and 2002-2008).

Main Results:

• Improved operative outcomes in the later period (2002-2008) including shorter operative time, more lymph nodes retrieved, and less blood loss.
• Significantly lower conversion rates in the later period (5.1% vs. 19.7%, p < 0.001).
• No significant differences in intra-operative or major post-operative complication rates between periods; steady states reached around 50 cases for complications and 310 for conversion rates.

Conclusions:

• Laparoscopic colorectal resection outcomes demonstrate significant improvement with accumulated surgical experience.
• Continuous training of new surgeons within an established, specialized unit does not adversely affect operative outcomes.