Defining a learning curve for laparoscopic colorectal resections

PURPOSE: The purpose of this review was to define the learning curve for la paroscopic colorectal resections. METHODS: A prospectively accumulated, com puterized database of all laparoscopic colorectal resections performed bg t hree surgeons between April 1991 and March 1999 was reviewed. RESULTS: A to tal of 461 consecutive resections were evenly distributed among three surge ons (141, 155, and 165). Median operating time was 180 minutes for Cases 1 to 30 in each surgeon's experience and declined to a steady state (150-167. 5 minutes) for Cases 31 and higher. Subsequently, Cases 1 to 30 were consid ered "early experience," whereas Cases 31 and higher were combined as "late experience" for statistical analysis. There were no significant difference s between patients undergoing resections in the early experience and those undergoing resections in the late experience with respect to age, weight, o r proportion of patients with malignancy, diverticulitis, or inflammatory b owel disease. There were greater proportions of males (42 vs. 51 percent, P = 0.046) and rectal resections performed (14 vs. 32 percent, P = 0.002) in the late experience. Trends toward declining rates of intraoperative compl ications (9 vs. 7 percent, P = 0.70) and conversion to open surgery (13.5 v s. 3.7 percent, P = 0.33) were observed with experience. Median operating t ime (180 vs. 160 minutes, P < 0.001) and overall length of postoperative ho spital stay (6.5 vs. 5 days, P < 0.001) declined significantly with experie nce. There was no difference in the rate of postoperative complications bet ween early and late experience (30 vs. 32 percent, P = 0.827). CONCLUSIONS: The learning curve for performing colorectal resections was approximately 30 procedures in this study, based on a decline in operating rime, intraope rative complications, and conversion rate. Learning was also extended to cl inical care because it was appreciated that patients could be discharged to their homes more quickly.