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Title of Journal: Surg Endosc

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Abbravation: Surgical Endoscopy

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Springer-Verlag

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DOI

10.1016/0020-711x(84)90247-7

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1432-2218

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Evaluation of the learning curve in laparoscopic l

Authors: Hajime Kayano Junji Okuda Keitaro Tanaka Keisaku Kondo Nobuhiko Tanigawa
Publish Date: 2011/04/22
Volume: 25, Issue: 9, Pages: 2972-2979
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Abstract

Laparoscopic low anterior resection for rectal cancer is considered to be more technically demanding than laparoscopic colectomy This study aimed to analyze the learning curve for laparoscopic low anterior resection and to identify the factors that influence this learning curveData from 250 consecutive patients undergoing laparoscopic low anterior resection for rectal cancer excluding patients with a combined resection such as cholecystectomy hepatectomy hysterectomy or gastrectomy between December 1996 and April 2010 were analyzed For operative time the learning curve was analyzed using the moving average method The conversion rate and the postoperative complication rate were evaluated in five groups of up to 50 patients each based on the number of cases required for analysis of operative time In addition risk factors that influenced conversion to open surgery and postoperative complications were analyzedThe learning curve analysis for operative time using the moving average method showed stabilization at 50 cases The conversion rate decreased significantly by group 4 151–200 cases The postoperative complication rate decreased significantly by group 5 201–250 cases The significant factors for conversion to open surgery were male sex odds ratio OR 26094 95 confidence interval CI 11–64 and T stage OR 24793 95 CI 11–58 For postoperative complications male sex OR 38590 95 CI 19–38 was significant In addition the risk factors for anastomotic leakage were male sex OR 157659 95 CI 32–2848 and multiple firing 2 or more cartridges for rectal transection OR 30589 95 CI 11–95The risk factors affecting the learning curve for laparoscopic low anterior resection were T stage and male sex In laparoscopic low anterior resection rectal transection in particular can be technically difficult and standardization for accurate performance of the same technique for expanded indications is very important

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