Purpose: Laparoscopic colorectal surgery has long learning curve because of complex mesenteric blood supply, multiple quadrant location and bowel anastomosis. The aim of this study was to identify the learning curve for laparoscopic colorectal surgery.
Methods: From April 2000 to July 2002, Ninety laparoscopic colectomy were performed at Samung Medical Center. The cases were divided into 3 groups: 1 to 30 Cases as early group, 31 to 60 cases as intermediate group and 61 to 90 cases as late group. As for type of surgery, total 48 cases of anterior resection were divided as 2 groups (AR-early group and AR-late group), total 20 cases of right hemicolectomy were divided as 2 groups (RH-early group and RH-late group). We retrospectively analyzed conversion rate, operative time, length of postoperative hospital stay and complication rate.
Results: The conversion rate was significantly higher in early group (3 cases, 10.0%) than intermediate group (0 case, 0.0%) and late group (0 case, 0.0%: p＜0.04). The reasons for conversion were postoperative adhesive band, anatomical variation of greater omentum and mesenteric lymph node enlargement. Mean operative time declined significantly from early group (179±49 minutes) to intermediate group (151±34 minutes) and late group (148±39) minutes: p＜0.008). Comparing postoperative length of hospital stay, there were no differences in early group (7.6±1.0 days), intermediate group (7.4±1.1 days) and late group (7.0±0.7) days: p＜0.07). Complication consisted of urinary retension (4 cases), anastomotic site delayed bleeding (3 cases), chyle leakage (3 cases) and wound infection (one case). The complication rate showed no differences between three groups (p＜0.26). There were no significant difference between early group and late group of anterior resection, 0.26). There were no significant difference between early late group of anterior resection, and also right hemicolectomy.
Conclusion: Based on a decline tin conversion rate, operative time and complication, this study showed that learning curve for laparoscopic colorectal surgery did not take as much time, and the estimated learning curve performing colorectal surgery was approximately 30 cases.
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