AN OBJECTIVE EXPERIMENTAL ASSESSMENT OF THE LEARNING-CURVE FOR LAPAROSCOPIC SURGERY - THE EXAMPLE OF PELVIC AND PARAAORTIC LYMPH-NODE DISSECTION

Objectives: To date the number of procedures required to become compet ent to perform new laparoscopic surgical techniques is not known. Stud y design: The pig model was chosen for assessment of the learning curv e associated with an advanced laparoscopic procedure. A unilateral lap aroscopic 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 imme diate laparotomy by an independant observer. Results: The operative ob jectives 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-aor tic lymphadenectomy. Conclusion: It is feasible to assess the learning curve of trainee surgeons while performing laparoscopic pelvic and pa ra-aortic lymphadenectomy on pigs. A training programme such as this s hould prevent complications due to inexperience and should satisfy eth ical and medico-legal considerations. (C) 1998 Elsevier Science Irelan d Ltd. All rights reserved.