Reaching proficiency in laparoscopic splenectomy

Nursal, Tarik Zafer; Ezer, Ali; Belli, Sedat; Parlakgumus, Alper; Caliskan, Kenan; Noyan, Turgut; Rodriguez, Damian Casadesus
August 2009
World Journal of Gastroenterology;8/28/2009, Vol. 15 Issue 32, p4005
Academic Journal
AIM: To investigate the proficiency level reached in laparoscopic splenectomy using the learning curve method. METHODS: All patients in need of splenectomy for benign causes in whom laparoscopic splenectomy was attempted by a single surgeon during a time period of 6 years were included in the study (n = 33). Besides demographics, operation-related variables and the response to surgery were recorded. The patients were allocated to groups of five, ranked according to the date of the operation. Operation duration, complications, postoperative length of stay, conversion to laparotomy and splenic weight were then compared between these groups. RESULTS: There was a significant difference regarding operation times between the groups (P = 0.001). An improvement was observed after the first 5 cases. The learning curve was flat up to the 25th case. Following the 25th case the operation times decreased still further . There was no difference between the groups regarding the other parameters. CONCLUSION: Unlike the widely accepted "L" shape, the learning curve for laparoscopic splenectomy is a horizontal lazy "S" with two distinct slopes. Privileges may be granted after the first 5 cases. However proficiency seems to require 25 cases.


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