Laparoscopic Colectomy: Does the Learning Curve Extend Beyond Colorectal Surgery Fellowship?
Joshua A. Waters, MD, Ray Chihara, MD, Jose Moreno, MD, Bruce Robb, MD, Virgilio George, MD
Indiana University School of Medicine
Background: As minimally invasive colon and rectal resection has become increasingly prevalent over the past decade, the role that fellowship training plays has become an important question.
This analysis examines the learning curve of one fellowship trained colorectal surgeon in the first 100 cases.
Methods: This is a prospectively collected retrospective analysis of the first 100 laparoscopic colon and rectal resections performed between July 2007 and July 2008 by a CRS fellowship trained surgeon at a VA and county hospital. Included were all nonemergent laparoscopic cases.
Results: Mean age was 63 years (range, 36 to 91). These 100 resections included 42 right, 6 left, 32 sigmoid, 13 rectal, and 7 total colectomies. Indications were 55% cancer, 19% unresectable polyp, 18% diverticular disease, 4% inflammatory, and 4% other. Overall mortality was 3%. Morbidity including wound infection was 28%. Early and late groups showed no difference in age, ASA, or indication. Overall conversion rate was 4%. No statistical difference was seen in mortality, morbidity, EBL, LOS, margin, lymph nodes, or conversions between the first and second 50 cases (P<0.05). Right and sigmoid colectomy operative time decreased by 35% and 19%, respectively.
Conclusions: Prior investigators have demonstrated a significant learning curve in laparoscopic colorectal surgery. In the first 100 cases, no difference in mortality or morbidity occurred between early and late cases. Alternatively, operative times decreased over the first 100 cases. Laparoscopic experience during CRS fellowship surpasses the learning curve in regard to safety and outcome, whereas operative efficiency increases over the first year of practice.
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