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KMID : 0978820080110020111
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Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons
2008 Volume.11 No. 2 p.111 ~ p.119
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The Learning Curve for Laparoscopic Common Bile Duct Exploration through a Choledochotomy - Report on 50 Patients
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Hong Kyung-Min
Chia Byung-Doe
Seo Dong-Beom
Ku Ki-Beom
Park Kyung-Hwan
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Abstract
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Purpose: Since the indications for laparoscopic surgery have been broadened to encompass many abdominal surgeries, there have been many studies that have quantified the learning curve for each surgical procedure. This article is designed to estimate the learning curve for laparoscopic common bile duct exploration (LCBDE), as there are currently few reports on this.
Methods: Fifty consecutive laparoscopic common bile duct explorations through a choledochotomy were performed by one experienced laparoscopic surgeon who had carried out 283 laparoscopic cholecystectomies, and we retrospectively analyzed the data for the operative time, the number of long (≥ 180 minutes) and short (≤ 120 minutes) operations, the conversion rate, the ductal clearance rate and the complication rate. The relations between stone extraction methods and operative time were also analyzed.
Results: After 25 cases of laparoscopic common bile duct exploration, the mean operative time was significantly decreased from 177.6 to 136.6 minutes with a decrease in the number of long operations from 10 to 2 and there was an increase in the number of short ones from 1 to 12 (p ＜ 0.05). The conversion rate, ductal clearance rate and complication rate were 10%, 91% and 11%, respectively, with no statistically significant change. Performing electrohydraulic lithotripsy (EHL) and extracting impacted stones were still the time-consuming procedures even if the surgeon had experienced as many as 25 LCBDEs.
Conclusion: A laparoscopic surgeon who is proficient in laparoscopic cholecystectomy can reach the late phase of experience in performing LCBDE after the early phase of experiencing 25 cases of LCBDEs.
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KEYWORD
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Laparoscopic common bile duct exploration, Learning curve, Common bile duct stones, Laparoscopic choledochotomy, LCBDE
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