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An objective experimental assessment of the learning curve for laparoscopic surgery: the example of pelvic and
D Querleu1, D Lanvin, A Elhage
1Département Hospitalo-Universitaire de Recherche Expérimentale, Faculté de Médecine, Lille, France. dquerleu@chru-lille.fr
Objectives:
To date the number of procedures required to become competent to perform new laparoscopic surgical techniques is not known.
Study Design:
The pig model was chosen for assessment of the learning curve associated with an advanced laparoscopic procedure. A unilateral laparoscopic pelvic lymphadenectomy was performed by two residents and a laparoscopic para-aortic lymphadenectomy was performed by a fellow on a series of 20 pigs. The quality of the dissection was checked by immediate laparotomy by an independent observer.
Results:
The operative objectives were: (a) There should be less than 5% residual lymph nodes. (b) The operating time should be less than 30 min for pelvic and less than 100 min for para-aortic lymphadenectomy. (c) Avoiding conversion because of complications. This target was achieved after 7 and 9 pigs respectively for pelvic lymphadenectomy and after 14 pigs for para-aortic lymphadenectomy.
Conclusion:
It is feasible to assess the learning curve of trainee surgeons while performing laparoscopic pelvic and para-aortic lymphadenectomy on pigs. A training programme such as this should prevent complications due to inexperience and should satisfy ethical and medico-legal considerations.