Laparoscopic colorectal surgery in learning curve: Role of implementation of a standardized technique and recovery protocol. A cohort study
| Autor: | Viviana Sollazzo, Filomena Liccardo, Roberto Peltrini, R. Tarquini, Mariano Cesare Giglio, Giovanni Domenico De Palma, Emanuela Spadarella, Emanuela Esposito, Luigi Bucci, Gaetano Luglio |
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| Přispěvatelé: | Luglio, Gaetano, DE PALMA, GIOVANNI DOMENICO, Tarquini, R, Giglio, Mc, Sollazzo, V, Esposito, E, Spadarella, E, Peltrini, R, Liccardo, F, Bucci, Luigi |
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Protocol (science)
medicine.medical_specialty medicine.diagnostic_test business.industry Colorectal cancer Mortality rate General surgery General Medicine medicine.disease Colorectal surgery Article Surgery Standardized technique Laparoscopic colorectal surgery medicine Laparoscopy Single institution business Learning curve Cohort study Enhanced recovery programme |
| Zdroj: | Annals of Medicine and Surgery |
| Popis: | Background Despite the proven benefits, laparoscopic colorectal surgery is still under utilized among surgeons. A steep learning is one of the causes of its limited adoption. Aim of the study is to determine the feasibility and morbidity rate after laparoscopic colorectal surgery in a single institution, “learning curve” experience, implementing a well standardized operative technique and recovery protocol. Methods The first 50 patients treated laparoscopically were included. All the procedures were performed by a trainee surgeon, supervised by a consultant surgeon, according to the principle of complete mesocolic excision with central vascular ligation or TME. Patients underwent a fast track recovery programme. Recovery parameters, short-term outcomes, morbidity and mortality have been assessed. Results Type of resections: 20 left side resections, 8 right side resections, 14 low anterior resection/TME, 5 total colectomy and IRA, 3 total panproctocolectomy and pouch. Mean operative time: 227 min; mean number of lymph-nodes: 18.7. Conversion rate: 8%. Mean time to flatus: 1.3 days; Mean time to solid stool: 2.3 days. Mean length of hospital stay: 7.2 days. Overall morbidity: 24%; major morbidity (Dindo–Clavien III): 4%. No anastomotic leak, no mortality, no 30-days readmission. Conclusion Proper laparoscopic colorectal surgery is safe and leads to excellent results in terms of recovery and short term outcomes, even in a learning curve setting. Key factors for better outcomes and shortening the learning curve seem to be the adoption of a standardized technique and training model along with the strict supervision of an expert colorectal surgeon. Highlights • Benefits from laparoscopic colorectal surgery have been widely demonstrated. • A steep learning curve is considered the main limitation to its adoption. • We present short-term outcomes in a learning curve prospective series. • A modular, stepwise approach leads to excellent results. • Even trainees can safely learn both laparoscopic and open surgery, when strictly supervised. |
| Databáze: | OpenAIRE |
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