LAPAROSCOPIC COLORECTAL SURGERY - DO WE GET FASTER

Background: A variety of parameters can affect the outcome of laparosc opic colorectal surgery. All consecutive laparoscopic colorectal proce dures (LCP) were analyzed in an attempt to define an operative time cu rve for different categories of procedures. Additionally, impacts of c ase number and procedure type on length of procedure were assessed. Me thods: Our computerized data system was reviewed for all patients who underwent LCP in a 4-year period. Parameters reviewed included age, se x, surgical indications, procedures performed, length of procedure, in traoperative and postoperative complications, incidence and causes for conversion, duration of postoperative ileus, and hospital stay. Resul ts: Between August 1991 and December 1995, 175 patients with a mean ag e of 48.4 (range 15-88) years underwent LCP. Patients were divided chr onologically into five consecutive groups. Procedures were classified as either basic or complex. Complex procedures were those in which the re was either a fixed tumor, an abscess or fistula, or extensive intra abdominal adhesions from prior surgery. Complex procedures performed e ach year ranged from 37% to 66%. As well, the percentage of patients w ith adhesions increased from 17% in 1991 to 29% in 1995. Despite incre ased difficulty, the intraoperative complication rate fell significant ly from 29% in 1991 to 8% in 1995 (p < 0.005). Additionally, the opera tive length decreased from a mean of 201 min in 1991 to a mean of 141 min in 1995 (p < 0.05). Conclusion: The rapid improvement in these par ameters may reflect both ascents in the learning curve and change in t ype of procedure. Adhesions, due to prior surgery or inflammation maki ng dissection tedious, is the most important technical factor which ef fects operation time (p < 0.001). However, despite increased complexit y, operating time decreased, reflecting improved skills. Thus, the exp erienced laparoscopic surgeon can increase the spectrum of application s with expectations of shorter operations and lower complication rates .