Laparoscopic colon resection early in the learning curve: What is the appropriate setting?

Daniel J. Reichenbach, A. Darrel Tackett, James Harris, Diego Camacho, Edward A. Graviss, Brendan Dewan, Ashley Vavra, Anquonette Stiles, William E. Fisher, F. Charles Brunicardi, John F. Sweeney

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

INTRODUCTION: Laparoscopic colon resection (LCR) is a safe and effective treatment of benign and malignant colonic lesions. There is little question that a steep learning curve exists for surgeons to become skilled and proficient at LCR. Because of this steep learning curve, debate exists regarding the appropriate hospital setting for LCR. We hypothesize that outcomes of LCR performed early in the learning curve at a regional medical center (New Hanover Regional Medical Center; NHRMC) and a university medical center (Baylor College of Medicine; BCM) would not be significantly different. METHODS: The first 50 consecutive LCRs performed at each institution between August 2001 and December 2003 were reviewed. Age, mean body mass index (BMI), gender, history of previous abdominal surgery (PAS), operative approach [laparoscopic (LAP) versus hand/laparoscopic assisted (HAL)], conversions (Conv), operative time (OR time), pathology (benign vs. malignant), lymph nodes (LN) harvested in malignant cases, length of stay (LOS), morbidity and mortality were obtained. Continuous data were expressed as mean ± SD. Data were analyzed by χ, Fisher exact test, or t test. RESULTS: NHRMC patients were on average older females with a higher incidence of PAS. A LAP approach was more frequently performed at BCM (86%), whereas HAL was used more frequently at NHRMC (24%). Conversions to open were similar at both institutions (12%). Benign disease accounted for the majority of operations at both institutions. In cases of malignancy, more LN were harvested at BCM. OR time and LOS were shorter at NHRMC. Complication rates were similar between institutions. There were no anastomotic leaks or deaths. CONCLUSIONS: LCR can be performed safely and with acceptable outcomes early in the learning curve at regional medical centers and university medical centers. Outcomes depend more on surgeons possessing advanced laparoscopic skills and adhering to accepted oncologic surgical principles in cases of malignancy, than on the size or location of the healthcare institution.

Original languageEnglish (US)
Pages (from-to)730-735
Number of pages6
JournalAnnals of Surgery
Volume243
Issue number6
DOIs
StatePublished - Jun 2006
Externally publishedYes

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Learning Curve
Colon
Operative Time
Length of Stay
Hand
Lymph Nodes
Anastomotic Leak
Neoplasms
Body Mass Index
Medicine
Pathology
Morbidity
Delivery of Health Care
Mortality
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Reichenbach, D. J., Tackett, A. D., Harris, J., Camacho, D., Graviss, E. A., Dewan, B., ... Sweeney, J. F. (2006). Laparoscopic colon resection early in the learning curve: What is the appropriate setting? Annals of Surgery, 243(6), 730-735. https://doi.org/10.1097/01.sla.0000220039.26524.fa

Laparoscopic colon resection early in the learning curve : What is the appropriate setting? / Reichenbach, Daniel J.; Tackett, A. Darrel; Harris, James; Camacho, Diego; Graviss, Edward A.; Dewan, Brendan; Vavra, Ashley; Stiles, Anquonette; Fisher, William E.; Brunicardi, F. Charles; Sweeney, John F.

In: Annals of Surgery, Vol. 243, No. 6, 06.2006, p. 730-735.

Research output: Contribution to journalArticle

Reichenbach, DJ, Tackett, AD, Harris, J, Camacho, D, Graviss, EA, Dewan, B, Vavra, A, Stiles, A, Fisher, WE, Brunicardi, FC & Sweeney, JF 2006, 'Laparoscopic colon resection early in the learning curve: What is the appropriate setting?', Annals of Surgery, vol. 243, no. 6, pp. 730-735. https://doi.org/10.1097/01.sla.0000220039.26524.fa
Reichenbach, Daniel J. ; Tackett, A. Darrel ; Harris, James ; Camacho, Diego ; Graviss, Edward A. ; Dewan, Brendan ; Vavra, Ashley ; Stiles, Anquonette ; Fisher, William E. ; Brunicardi, F. Charles ; Sweeney, John F. / Laparoscopic colon resection early in the learning curve : What is the appropriate setting?. In: Annals of Surgery. 2006 ; Vol. 243, No. 6. pp. 730-735.
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title = "Laparoscopic colon resection early in the learning curve: What is the appropriate setting?",
abstract = "INTRODUCTION: Laparoscopic colon resection (LCR) is a safe and effective treatment of benign and malignant colonic lesions. There is little question that a steep learning curve exists for surgeons to become skilled and proficient at LCR. Because of this steep learning curve, debate exists regarding the appropriate hospital setting for LCR. We hypothesize that outcomes of LCR performed early in the learning curve at a regional medical center (New Hanover Regional Medical Center; NHRMC) and a university medical center (Baylor College of Medicine; BCM) would not be significantly different. METHODS: The first 50 consecutive LCRs performed at each institution between August 2001 and December 2003 were reviewed. Age, mean body mass index (BMI), gender, history of previous abdominal surgery (PAS), operative approach [laparoscopic (LAP) versus hand/laparoscopic assisted (HAL)], conversions (Conv), operative time (OR time), pathology (benign vs. malignant), lymph nodes (LN) harvested in malignant cases, length of stay (LOS), morbidity and mortality were obtained. Continuous data were expressed as mean ± SD. Data were analyzed by χ, Fisher exact test, or t test. RESULTS: NHRMC patients were on average older females with a higher incidence of PAS. A LAP approach was more frequently performed at BCM (86{\%}), whereas HAL was used more frequently at NHRMC (24{\%}). Conversions to open were similar at both institutions (12{\%}). Benign disease accounted for the majority of operations at both institutions. In cases of malignancy, more LN were harvested at BCM. OR time and LOS were shorter at NHRMC. Complication rates were similar between institutions. There were no anastomotic leaks or deaths. CONCLUSIONS: LCR can be performed safely and with acceptable outcomes early in the learning curve at regional medical centers and university medical centers. Outcomes depend more on surgeons possessing advanced laparoscopic skills and adhering to accepted oncologic surgical principles in cases of malignancy, than on the size or location of the healthcare institution.",
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T2 - What is the appropriate setting?

AU - Reichenbach, Daniel J.

AU - Tackett, A. Darrel

AU - Harris, James

AU - Camacho, Diego

AU - Graviss, Edward A.

AU - Dewan, Brendan

AU - Vavra, Ashley

AU - Stiles, Anquonette

AU - Fisher, William E.

AU - Brunicardi, F. Charles

AU - Sweeney, John F.

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N2 - INTRODUCTION: Laparoscopic colon resection (LCR) is a safe and effective treatment of benign and malignant colonic lesions. There is little question that a steep learning curve exists for surgeons to become skilled and proficient at LCR. Because of this steep learning curve, debate exists regarding the appropriate hospital setting for LCR. We hypothesize that outcomes of LCR performed early in the learning curve at a regional medical center (New Hanover Regional Medical Center; NHRMC) and a university medical center (Baylor College of Medicine; BCM) would not be significantly different. METHODS: The first 50 consecutive LCRs performed at each institution between August 2001 and December 2003 were reviewed. Age, mean body mass index (BMI), gender, history of previous abdominal surgery (PAS), operative approach [laparoscopic (LAP) versus hand/laparoscopic assisted (HAL)], conversions (Conv), operative time (OR time), pathology (benign vs. malignant), lymph nodes (LN) harvested in malignant cases, length of stay (LOS), morbidity and mortality were obtained. Continuous data were expressed as mean ± SD. Data were analyzed by χ, Fisher exact test, or t test. RESULTS: NHRMC patients were on average older females with a higher incidence of PAS. A LAP approach was more frequently performed at BCM (86%), whereas HAL was used more frequently at NHRMC (24%). Conversions to open were similar at both institutions (12%). Benign disease accounted for the majority of operations at both institutions. In cases of malignancy, more LN were harvested at BCM. OR time and LOS were shorter at NHRMC. Complication rates were similar between institutions. There were no anastomotic leaks or deaths. CONCLUSIONS: LCR can be performed safely and with acceptable outcomes early in the learning curve at regional medical centers and university medical centers. Outcomes depend more on surgeons possessing advanced laparoscopic skills and adhering to accepted oncologic surgical principles in cases of malignancy, than on the size or location of the healthcare institution.

AB - INTRODUCTION: Laparoscopic colon resection (LCR) is a safe and effective treatment of benign and malignant colonic lesions. There is little question that a steep learning curve exists for surgeons to become skilled and proficient at LCR. Because of this steep learning curve, debate exists regarding the appropriate hospital setting for LCR. We hypothesize that outcomes of LCR performed early in the learning curve at a regional medical center (New Hanover Regional Medical Center; NHRMC) and a university medical center (Baylor College of Medicine; BCM) would not be significantly different. METHODS: The first 50 consecutive LCRs performed at each institution between August 2001 and December 2003 were reviewed. Age, mean body mass index (BMI), gender, history of previous abdominal surgery (PAS), operative approach [laparoscopic (LAP) versus hand/laparoscopic assisted (HAL)], conversions (Conv), operative time (OR time), pathology (benign vs. malignant), lymph nodes (LN) harvested in malignant cases, length of stay (LOS), morbidity and mortality were obtained. Continuous data were expressed as mean ± SD. Data were analyzed by χ, Fisher exact test, or t test. RESULTS: NHRMC patients were on average older females with a higher incidence of PAS. A LAP approach was more frequently performed at BCM (86%), whereas HAL was used more frequently at NHRMC (24%). Conversions to open were similar at both institutions (12%). Benign disease accounted for the majority of operations at both institutions. In cases of malignancy, more LN were harvested at BCM. OR time and LOS were shorter at NHRMC. Complication rates were similar between institutions. There were no anastomotic leaks or deaths. CONCLUSIONS: LCR can be performed safely and with acceptable outcomes early in the learning curve at regional medical centers and university medical centers. Outcomes depend more on surgeons possessing advanced laparoscopic skills and adhering to accepted oncologic surgical principles in cases of malignancy, than on the size or location of the healthcare institution.

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