The Learning Curve of Laparoscopic Colorectal Surgery in Regional Hospital

Purpose. In the early 1990s, laparoscopic colon surgery was shown to be technically feasible and was applied to managing benign and malignant colon disease. Few published discussions describe the learning curve for performing this procedure in regional hospital. Here we present our surgical experience and early outcomes for laparoscopic colorectal resection.
Methods. Our laparoscopic surgical team comprised well trained colorectal surgeons without prior experience performing laparoscopic colorectal surgery. From August 2008 to January 2009, we performed 30 laparoscopic colorectal surgeries. Two equal, consecutive groups, the first 15 cases (group A) and later 15 cases (group B), were retrospectively reviewed. Patient demographics, perioperative parameters and early outcomes (i.e., operative times, blood loss, length of stay, need for technique assistance, complications, conversion to open surgery) were recorded. Surgical experience and outcomes were analyzed to document our learning curve.
Results. No significant differences were found between groups in surgical procedures, gender ratios and difficulty of operative procedures. Group B had shorter operative times, earlier recovery of gastrointestinal function, less blood loss, and shorter hospital stays without significant differences. Significant differences between groups included higher ages in group B and higher incidence of calls for technical assistance in group A. The groups' complication rates were identical. Group A had the only case of conversion to open surgery. Operation times and blood loss decreased significantly after case 16.
Conclusions. Laparoscopic colorectal resection can be performed safely in regional hospital. Assistance from a surgeon experienced in laparoscopic colorectal resection helped, colorectal surgeons with laparoscopic experienced (laparoscopic cholecystectomy and laparoscopic appendectomy) achieve proficiency at 16 cases.