LAPAROSCOPIC-ASSISTED COLECTOMY - THE LEARNING-CURVE

One hundred fifty consecutive laparoscopic-assisted colectomies perfor med by a surgical team were analyzed in an attempt to define a learnin g curve, These colectomies performed by the Norfolk Surgical Group ove r a 24-month period, were divided chronologically into six groups of 2 5 patients each. The groups were then compared to determine if any imp rovement in length of procedure, complication rate, conversion rate, o r length of stay developed as experience increased, Colon cancer and d iverticular disease were the most common indications for surgery in al l groups. Right hemicolectomy, left colectomy, and low anterior resect ion accounted for the majority of procedures in all groups, A signific ant decrease in mean operative time, from 250 min to 156 min over the first 35-50 cases was observed before leveling off at approximately 14 0 min for the remaining groups, Intraoperative complications were low in all groups (range zero to two) and did not show any trend, There wa s no statistically significant difference in the conversion rate (23.3 % overall) among the six groups, Length of stay decreased from 6 days in the first two groups to 5 days in the last four groups, although th e difference was not statistically significant, The learning curve for laparoscopic-assisted colectomies is longer than appreciated by many surgeons, requiring as many as 35-50 procedures to decrease operative time to baseline. Complications can be kept at an acceptably low level while on the curve if a cautious approach is taken and the surgeon re alizes that a prolonged operative time is not only acceptable, but app ropriate during this long learning process. A conversion rate of 20-25 % at any phase of the learning process may in fact represent a limitat ion of current technology, When combined with a low complication rate it may be the sign of a careful surgeon.