Chirurgia colo-rettale laparoscopica: è necessaria la “curva di apprendimento”?

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Elio Jovine, Fernando Talarico, Federico Bolchini, Giovanni Landolfo, Laura Mastrangelo, Maria Federica Lerro, Federica Martuzzi, Simonetta Selleri, Andrea Lazzari, Domenico Rosario Iusco, Giuseppe Gizzi

Ann. Ital. Chir., 2005; 76: 183-187

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AIM OF THE STUDY: To present the early experience of the Authors’ division in the field of colorectal laparoscopic surgery,
in order to evaluate the so-called “learning curve”.
MATERIALS AND METHOD: From February 2003 to May 2004, we have performed 220 surgical procedures for colorectal
pathology: 63 were conducted by a laparoscopic approach with 10 patients who, converted to a laparotomic procedure
in theatre, were not taken under consideration.
The present work is thus based on a population of 53 patients, 27 men and 26 women, at a median age of 64.4 y.o.
(range 42-81).
RESULTS: We performed 1 total colectomy, 24 right hemicolectomy, 1 resection of the splenic flexure, 12 left hemicolectomy
(in 1 case a left hepatic lobectomy was associated), 11 anterior resection of the rectum, 1 Hartmann’ sigmoid resection
and 3 abdomino-perineal resection.
Mean operative time was 200.34±64.17 min, while the mean hospital stay was 6.44±2.68 days.
Peri-operative mortality was 0%, 30-days mortality was 1/53 patients (9%) while morbidity was 5/53 patients (9.4%):
in 2 cases reintervention was necessary.
DISCUSSION: From the evaluation of the results, we found some significant data: first, the conversion rate was similar
to those reported by other authors, so also the mortality and morbidity rates.
CONCLUSIONS: The advantages of the laparoscopic technique, indirectly documented by shorter in-hospital stay.
At least for patients submitted to right or left hemicolectomy withouth complications (5.5 e 5.7 days, respectively), could
be seen also after only a 1 year of activity.
As far as the “learning curve” is concerned, dividing our activity into 3 times, we verified a progressive shortening of
the operative time and, at least for the patients submitted to a right emicolecomy, also of the morbidity rates.

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