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Impact of Experience on Quality Outcomes in Single-incision Cholecystectomy in Children
Sandra M Farach1, Paul D Danielson, Ernest K Amankwah
1Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, Florida, USA.
Insights
Single-incision laparoscopic cholecystectomy (SILC) is safe for children. Operative times decreased significantly after a learning curve and remained consistent even with surgical trainees involved.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Single-incision laparoscopic cholecystectomy (SILC) is a minimally invasive technique for children.
- Factors influencing SILC outcomes in pediatric patients require further investigation.
Purpose of the Study:
- To evaluate the learning curve and impact of surgical trainees on outcomes of SILC in children.
- To assess the safety and efficiency of SILC adoption in pediatric surgical practice.
Main Methods:
- Retrospective review of 151 pediatric patients undergoing SILC (2009-2013).
- Analysis of operative times and complications across early, late, and trainee-involved cases.
- Regression analysis to identify learning curve inflection points.
Main Results:
- Operative times significantly decreased from early to late SILC cases (75.3 vs 56.1 minutes, P < 0.05).
- Involvement of surgical trainees did not significantly increase operative times (56.1 vs 60.4 minutes, P = NS).
- Overall complication rate was 6%, with no significant differences between groups; 3.3% conversion rate.
Conclusions:
- A short learning curve allows for significantly decreased operative times in pediatric SILC.
- SILC can be safely and efficiently introduced into pediatric surgical practices, even with trainee involvement.
- Sustained operative efficiency is achievable with trainees participating in SILC procedures.
Abstract:
Single-incision laparoscopic cholecystectomy (SILC) has been shown to be safe in children; however, factors that impact outcomes are not well understood. We report a retrospective review of 151 patients who underwent SILC between 2009 and 2013. Regression analysis was used to determine inflection of learning curve. Patients were grouped by early cases, late cases, and late case with surgical trainees. Mean age for all patients was 15 ± 3 years (5-20.5 year), and mean weight was 66.5 ± 21.3 kg (15-117 kg). There was a decrease in operative times between the early group (n = 15) and the late group (n = 100) (75.3 vs 56.1 minutes, P < 0.05). Surgical trainees were involved in 36 cases, and their introduction did not significantly increase operative times (56.1 vs 60.4 minutes, P = NS (Non-significant)). No difference in operative times between early cases and cases with trainees was identified (75.3 vs 60.4 minutes, P = NS). The complication was 6 per cent, with no significant differences between the groups. There were five conversions (3.3%). During the adoption of SILC, significantly decreased operative times were achieved after a short learning curve, and these were maintained with surgical trainees. Our results show that SILC can be safely introduced into a pediatric surgical practice.
