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Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is lengthy - analysis of learning curves for a novice minimally invasive surgeon.

 George Melich  ;  Duck Hyoun Jeong  ;  Hyuk Hur  ;  Seung Hyuk Baik  ;  Julio Faria  ;  Nam Kyu Kim  ;  Byung Soh Min 
 CANADIAN JOURNAL OF SURGERY, Vol.57(5) : 331-336, 2014 
Journal Title
Issue Date
Aged ; Clinical Competence* ; Colectomy/education* ; Colectomy/methods ; Colonic Neoplasms/surgery* ; Education, Medical, Continuing/standards* ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/education* ; Laparoscopy/methods ; Learning Curve* ; Male ; Mesocolon/surgery* ; Middle Aged ; Minimally Invasive Surgical Procedures/education ; Minimally Invasive Surgical Procedures/methods ; Operative Time ; Retrospective Studies ; Treatment Outcome
BACKGROUND: Associated with reduced trauma, laparoscopic colon surgery is an alternative to open surgery. Furthermore, complete mesocolic excision (CME) has been shown to provide superior nodal yield and offers the prospect of better oncological outcomes. METHODS: All oncologic laparoscopic right colon resections with CME performed by a single surgeon since the beginning of his surgical practice were retrospectively analyzed for operative duration and perioperative outcomes. RESULTS: The study included 81 patients. The average duration of surgery was 220.0 (range 206-233) minutes. The initial durations of about 250 minutes gradually decreased to less than 200 minutes in an inverse linear relationship (y = -0.58x × 248). The major complication rate was 3.6% ± 4.2% and the average nodal yield was 31.3 ± 4.1. CumulativeSum analysis showed acceptable complication rates and oncological results from the beginning of surgeon's laparoscopic career. CONCLUSION: Developing laparoscopic skills can provide acceptable outcomes in advanced right hemicolectomy for a surgeon who primarily trained in open colorectal surgery. Operative duration is nearly triple that reported for conventional laparoscopic right hemicolectomy. The slow operative duration learning curve without a plateau reflects complex anatomy and the need for careful dissection around critical structures. Should one wish to adopt this strategy either based on some available evidence of superiority or with intention to participate in research, one has to change the view of right hemicolectomy being a rather simple case to being a complex, lengthy laparoscopic surgery.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Baik, Seung Hyuk(백승혁) ORCID logo https://orcid.org/0000-0003-4183-2332
Jeong, Duck Hyoun(정덕현)
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
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