How many years does it take for a general surgeon to gain proficiency in laparoscopic colectomy? a...

The point at which surgeons become technically independent in laparoscopic colectomy remains unclear. We analyzed learning curves by postgraduate year (PGY) to determine when proficiency was gained.

We analyzed 391 laparoscopic colectomies performed by 52 surgeons with ≤ 15 years of experience. The cases were grouped as R (ileocecal/right hemicolectomy) or S (sigmoid colectomy/high anterior resection). Learning curves were evaluated using CUSUM, logistic regression was used to identify the factors influencing operative time, and complication rates by PGY were examined.

The mean operative time improved from 232 min (4th PGY) to 165 min (7th PGY) in Group R and from 212 min (4th PGY) to 132 min (11th PGY) in Group S. A CUSUM analysis showed plateaus at the 7th PGY for Group R and the 11th PGY for Group S. Logistic regression revealed that the number of surgeries performed before these plateaus independently predicted the operative time (Group R: OR 3.32, p < 0.01; Group S: OR 3.67, p < 0.01). Complication rates peaked in the first two years and around the 12th PGY.

Surgical experience improved efficiency, with operative time plateauing at approximately the 11th PGY. Bimodal complication peaks in the first two years and the 12th PGY suggest proficiency after the 13th year.