Katherine A Kirk, MD, Brian A Boone, MD, Leonard Evans, MD, Steven Evans, MD, David L Bartlett, MD, Matthew P Holtzman, MD. University of Pittsburgh Medical Center.
Single incision right colectomy has emerged as a safe and feasible alternative to standard laparoscopic resection. As with any new surgical approach, definition of the number of procedures required to optimize the technique is an important goal. This learning curve for single incision right colectomy has yet to be defined; therefore we report the outcomes of consecutive single incision right colectomies to identify the procedural learning curve.
METHODS AND PROCEDURES
We retrospectively reviewed 70 consecutive single incision right colectomies performed by a single surgeon from May 2010 to May 2013. Patients with benign and malignant indications for right colon resection were offered single incision right colectomy. Patients were evaluated in groups of 10 to minimize individual patient variability and selection bias. Demographics and peri-operative outcomes among groups were evaluated using ANOVA or Kruskal-Wallis. Statistical improvement was assessed between groups using Student T-tests or Mann-Whitney U-tests.
The average age of patients in this series was 66.7±14.5 years and 40% were male. 58.6% had prior abdominal surgery. 68.6% of patients were undergoing resection for malignancy. There were no differences in patient demographics throughout the groups, suggesting that selection bias did not influence outcomes. There was a statistical improvement in operative time after the first 10 cases (102.8 vs 129.5 min, p=0.01, Figure 1). A second statistical improvement in operative time occurred after 40 cases (96.9 vs 114 min, p=0.03). There was no statistical improvement in estimated blood loss, lymph node harvest, conversion rate, length of stay, or post-operative morbidity throughout the experience (Table 1).
Analysis of our large series of consecutive cases indicates that, for a surgeon trained in advanced laparoscopic techniques, outcomes from the procedure are quickly optimized with a minimal learning curve. Operative time is optimized following 40 procedures. Identification of the learning curve is critical for surgeons wishing to implement a single-incision approach and to ensure outcomes are optimized prior to thorough comparison to standard laparoscopic or open approaches.