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Learning Curve in Laparoscopic Colorectal Surgery. Results of a Retrospective Personal Study

Vesselin Marinov


INTRODUCTION: Nowadays the term learning curve is widely accepted in the colorectal minimally invasive surgery and defines the level of education in the performance of a specific minimally invasive operation. The term has its own graphical image. The learning curve is completed when variations in one operative procedure have a stable level and the results are comparable with the published in the literature. The results can be identified by perioperative data—operative time, perioperative blood loss, level of conversions, perioperative morbidity, mortality rate, wound infection, rehospitalizations. On the other hand, in oncological cases, the number of harvested lymph nodes, tumor and circumferential resection margins, disease free survival are indicators which can be measured. There are a lot of approaches applied in surgical practice to complete the learning curve faster.  The number of operations to achieve a plateau in the learning curve is under debate in the literature.

AIM: The aim of this article is to analyze perioperative data and define the number of laparoscopic colorectal operations until reaching a plateau in the learning curve.

MATHERIALS AND METHODS: А single surgeon-based retrospective study on 183 minimally invasive colorectal resections analyzed the perioperative results in the time to achieve a plateau in the learning curve. The analyzed criteria were median operative time, blood loss, perioperative morbidity, level of conversions, median hospital stay, number of harvested lymph nodes. All the clinical methods were included.

RESULTS: The level of perioperative complications decreased from 30% in 2014 to under 15% in 2018, with small variations up to date. The median hospital stay dropped from 7.5 days at the beginning to 6.5 days in 2018, blood loss became stable in median range of 73 mL in 2018. The number of extracted lymph nodes rose from 9.6 to 13.22 and more. After 2018, the conversion rate became stable in range of 16%.

CONCLUSION:  To complete the learning curve, we identified 38 personally performed laparoscopic colorectal resections. The surgeon had previous personal experience of more than 100 open colorectal resections before the first laparoscopic one.


learning curve, laparoscopic, colorectal resection

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About The Author

Vesselin Marinov
Medical University of Varna, Bulgaria HBP and General Surgery Clinic, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria

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