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


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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