Single Port Laparoscopic Colectomy: the Learning Curve

Ovunc Bardakcioglu, MD FACS. Saint Louis University

Single port laparoscopic colectomy: the learning curve

Ovunc Bardakcioglu, M.D.

Section of Colon&Rectal Surgery, Department of Surgery, Saint Louis University, Saint Louis, MO

Background: Single port laparoscopic colectomy is described as a new technique in laparoscopic colorectal surgery. Although multiple series are reported there is little known regarding the learning curve for this advanced laparoscopic technique. The purpose of this study is to present a single colorectal surgeon’s experience with single port laparoscopic colectomy to allow the description of the learning curve.

Methods: Between July 2009 and January 2010, 16 patients with the indication for a right hemicolectomy underwent a single incision laparoscopic approach without selection bias. The only exclusion criterium was a prior midline laparotomy. Data collected included age, gender, BMI, PMH and ASA status, indication for surgery, procedure, length of surgery, blood loss, complications, length of stay and 30 day morbidity and mortality.

Results: Colon cancer and un-resectable polyps were the indication for surgery in all patients. Right hemicolectomy accounted for the majority of procedures performed. There was no mortality and no significant morbidity within 30 days. A significant and constant decrease in mean operative time, from 270 to 100 min was observed within this case series.

Discussion: Single incision laparoscopic right hemicolectomy can be safely performed as an oncologic resection for patients who were candidates for conventional laparoscopic or hand-assisted partial colectomy. The 30 day morbidity remained very low with this technique. The higher technical difficulty compared to conventional laparoscopy is reflected in the initial longer operative times. The learning curve for a surgeon with advanced laparoscopic skills and adequate procedure numbers seems to be short requiring about 10-15 procedures to decrease operative times to baseline.The role and feasibility of broad adaptation for single incision laparoscopy in colorectal surgery needs to be further evaluated in larger case series and trials.