Competence acquisition for single-incision laparoscopic cholecystectomy.

Area of Science:

• Minimally invasive surgery
• Biliary disease management
• Surgical education and training

Background:

• Single-incision laparoscopic cholecystectomy (SILC) represents a further advancement in minimally invasive approaches for biliary disease.
• The adoption of SILC necessitates an understanding of its learning curve for surgeons.

Purpose of the Study:

• To evaluate the learning curve associated with performing single-incision laparoscopic cholecystectomy.
• To compare the experiences of four individual surgeons with varying levels of expertise.

Main Methods:

• Retrospective review of 290 SILC procedures performed by general surgeons at three institutions.
• Analysis of procedure times, chronologically ordered per surgeon, and grouped into cohorts of 5 and 10 cases.
• Assessment of operative efficiency and identification of trends in procedure duration.

Main Results:

• Only one surgeon, fellowship-trained with less than 5 years of experience, demonstrated a learning curve, achieving proficiency within 15 cases.
• Other surgeons exhibited variable procedure times without a clear trend.
• Increased body mass index correlated with slightly longer operative times; conversion rate to multiport surgery was 3.1%.

Conclusions:

• Experienced general surgeons do not appear to have a significant learning curve when transitioning to SILC.
• Sufficient laparoscopic surgery experience (over 5 years) may obviate the need for a distinct SILC learning curve.
• The least experienced surgeon reached proficiency relatively quickly, suggesting SILC is readily adoptable.