Multidimensional analysis of the learning curve for laparoscopic colorectal surgery in a regional hospital: the implementation of a standardized surgical procedure counterbalances the lack of experience
Abstract Background Although a larger proportion of colorectal surgeries have been performed laparoscopically in the last few years, a steep learning curve prevents us from considering laparoscopic colorectal surgery as the gold standard technique for treating disease entities in the colon and rectu...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-12-01
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| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12893-020-00975-6 |
| _version_ | 1818353256930213888 |
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| author | Ioannis G. Gkionis Mathaios E. Flamourakis Eleni S. Tsagkataki Eleni I. Kaloeidi Konstantinos G. Spiridakis Georgios E. Kostakis Athanasios K. Alegkakis Manousos S. Christodoulakis |
| author_facet | Ioannis G. Gkionis Mathaios E. Flamourakis Eleni S. Tsagkataki Eleni I. Kaloeidi Konstantinos G. Spiridakis Georgios E. Kostakis Athanasios K. Alegkakis Manousos S. Christodoulakis |
| author_sort | Ioannis G. Gkionis |
| collection | DOAJ |
| description | Abstract Background Although a larger proportion of colorectal surgeries have been performed laparoscopically in the last few years, a steep learning curve prevents us from considering laparoscopic colorectal surgery as the gold standard technique for treating disease entities in the colon and rectum. The purpose of this single centre study was to determine, using various parameters and following a well-structured and standardized surgical procedure, the adequate number of cases after which a single surgeon qualified in open surgery but with no previous experience in laparoscopic colorectal surgery and without supervision, can acquire proficiency in this technique. Methods From 2012 to 2019, 112 patients with pathology in the rectum and colon underwent laparoscopic colorectal resection by a team led by the same surgeon. The patients were divided into two groups (group A:50 – group B:62) and their case records and histopathology reports were examined for predefined parameters, statistically analysed and compared between groups. Results There was no significant difference between groups in the distribution of conversions (p = 0.635) and complications (p = 0.637). Patients in both groups underwent surgery for the same median number of lymph nodes (p = 0.145) and stayed the same number of days in the hospital (p = 0.109). A statistically important difference was found in operation duration both for the total (p = 0.006) and for each different type of colectomy (sigmoidectomy: p = 0.026, right colectomy: p = 0.013, extralevator abdominoperineal resection: p = 0.050, low anterior resection: p = 0.083). Conclusions Taking into consideration all the parameters, it is our belief that a surgeon acquires proficiency in laparoscopic colorectal surgery after performing at least 50 diverse cases with a well structured and standardized surgical procedure. |
| first_indexed | 2024-12-13T19:06:39Z |
| format | Article |
| id | doaj.art-714b33bf7fb54df49c188d93d2e04290 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-13T19:06:39Z |
| publishDate | 2020-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-714b33bf7fb54df49c188d93d2e042902022-12-21T23:34:31ZengBMCBMC Surgery1471-24822020-12-012011910.1186/s12893-020-00975-6Multidimensional analysis of the learning curve for laparoscopic colorectal surgery in a regional hospital: the implementation of a standardized surgical procedure counterbalances the lack of experienceIoannis G. Gkionis0Mathaios E. Flamourakis1Eleni S. Tsagkataki2Eleni I. Kaloeidi3Konstantinos G. Spiridakis4Georgios E. Kostakis5Athanasios K. Alegkakis6Manousos S. Christodoulakis7Department of General Surgery, Venizeleio General HospitalDepartment of General Surgery, Venizeleio General HospitalDepartment of General Surgery, Venizeleio General HospitalDepartment of General Surgery, Venizeleio General HospitalDepartment of General Surgery, Venizeleio General HospitalDepartment of General Surgery, Venizeleio General HospitalMedical School, University of CreteDepartment of General Surgery, Venizeleio General HospitalAbstract Background Although a larger proportion of colorectal surgeries have been performed laparoscopically in the last few years, a steep learning curve prevents us from considering laparoscopic colorectal surgery as the gold standard technique for treating disease entities in the colon and rectum. The purpose of this single centre study was to determine, using various parameters and following a well-structured and standardized surgical procedure, the adequate number of cases after which a single surgeon qualified in open surgery but with no previous experience in laparoscopic colorectal surgery and without supervision, can acquire proficiency in this technique. Methods From 2012 to 2019, 112 patients with pathology in the rectum and colon underwent laparoscopic colorectal resection by a team led by the same surgeon. The patients were divided into two groups (group A:50 – group B:62) and their case records and histopathology reports were examined for predefined parameters, statistically analysed and compared between groups. Results There was no significant difference between groups in the distribution of conversions (p = 0.635) and complications (p = 0.637). Patients in both groups underwent surgery for the same median number of lymph nodes (p = 0.145) and stayed the same number of days in the hospital (p = 0.109). A statistically important difference was found in operation duration both for the total (p = 0.006) and for each different type of colectomy (sigmoidectomy: p = 0.026, right colectomy: p = 0.013, extralevator abdominoperineal resection: p = 0.050, low anterior resection: p = 0.083). Conclusions Taking into consideration all the parameters, it is our belief that a surgeon acquires proficiency in laparoscopic colorectal surgery after performing at least 50 diverse cases with a well structured and standardized surgical procedure.https://doi.org/10.1186/s12893-020-00975-6Learning curveColorectalLaparoscopyStandardized surgical procedureWithout supervision |
| spellingShingle | Ioannis G. Gkionis Mathaios E. Flamourakis Eleni S. Tsagkataki Eleni I. Kaloeidi Konstantinos G. Spiridakis Georgios E. Kostakis Athanasios K. Alegkakis Manousos S. Christodoulakis Multidimensional analysis of the learning curve for laparoscopic colorectal surgery in a regional hospital: the implementation of a standardized surgical procedure counterbalances the lack of experience BMC Surgery Learning curve Colorectal Laparoscopy Standardized surgical procedure Without supervision |
| title | Multidimensional analysis of the learning curve for laparoscopic colorectal surgery in a regional hospital: the implementation of a standardized surgical procedure counterbalances the lack of experience |
| title_full | Multidimensional analysis of the learning curve for laparoscopic colorectal surgery in a regional hospital: the implementation of a standardized surgical procedure counterbalances the lack of experience |
| title_fullStr | Multidimensional analysis of the learning curve for laparoscopic colorectal surgery in a regional hospital: the implementation of a standardized surgical procedure counterbalances the lack of experience |
| title_full_unstemmed | Multidimensional analysis of the learning curve for laparoscopic colorectal surgery in a regional hospital: the implementation of a standardized surgical procedure counterbalances the lack of experience |
| title_short | Multidimensional analysis of the learning curve for laparoscopic colorectal surgery in a regional hospital: the implementation of a standardized surgical procedure counterbalances the lack of experience |
| title_sort | multidimensional analysis of the learning curve for laparoscopic colorectal surgery in a regional hospital the implementation of a standardized surgical procedure counterbalances the lack of experience |
| topic | Learning curve Colorectal Laparoscopy Standardized surgical procedure Without supervision |
| url | https://doi.org/10.1186/s12893-020-00975-6 |
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