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. 2015 Mar 20;4(2):89-94.
doi: 10.1016/j.amsu.2015.03.003. eCollection 2015 Jun.

Laparoscopic colorectal surgery in learning curve: Role of implementation of a standardized technique and recovery protocol. A cohort study

Gaetano Luglio  1 , Giovanni Domenico De Palma  2 , Rachele Tarquini  1 , Mariano Cesare Giglio  1 , Viviana Sollazzo  1 , Emanuela Esposito  1 , Emanuela Spadarella  1 , Roberto Peltrini  1 , Filomena Liccardo  1 , Luigi Bucci  1
Affiliations

Laparoscopic colorectal surgery in learning curve: Role of implementation of a standardized technique and recovery protocol. A cohort study

Gaetano Luglio et al. Ann Med Surg (Lond). .

Abstract

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.

Keywords: Colorectal cancer; Enhanced recovery programme; Laparoscopic colorectal surgery; Laparoscopy; Learning curve.

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