SS  Vol.4 No.10 , October 2013
Evaluation of the Single-Port Laparoscopic Right Hemicolectomy Learning Curve
Abstract: Background: The use of single-port laparoscopy has gained popularity within recent years. Part of the appeal in learning this approach is that it draws heavily from concepts mastered through conventional laparoscopy. Various studies have shown the efficacy and feasibility of the single-port laparoscopic approach, but there are few that examine the learning curve in adopting this new technique. Objective: Our goal was to better define the learning curve in performing a single-port laparoscopic right hemicolectomy. Design: A review of prospectively gathered operative data was performed to analyze the results of single-port laparoscopic right hemicolectomies performed within our institution by experienced laparoscopic surgeons. The first 100 cases were divided into quintiles. Comparisons were made among the cohorts regarding patient demographics, operative time, length of stay, conversions, and complications. Results: There was no difference among quintiles with regard to age, sex, BMI, or ASA class. Operative time, conversions, length of stay, and number of complications did not significantly vary among each group of patients. There was a significant difference in estimated blood loss and length of stay between the fifth cohort and the others due to one patient’s poor outcome. Conclusions: The single-port laparoscopic right hemicolectomy learning curve for surgeons already skilled in laparoscopy is short. There are few differences in various outcome measures among groups at any stage in the learning curve. The skills utilized to perform conventional laparoscopic colorectal surgery readily translate to the single-port approach and result in proficiency from nearly the start.
Cite this paper: V. George, M. Guzman, J. Waters, A. Jester, D. Selzer and B. Robb, "Evaluation of the Single-Port Laparoscopic Right Hemicolectomy Learning Curve," Surgical Science, Vol. 4 No. 10, 2013, pp. 433-437. doi: 10.4236/ss.2013.410085.

[1]   P. Bucher, F. Pugin and P. Morel, “Single Port Access Laparoscopic Right Hemicolectomy,” International Journal of Colorectal Disease, Vol. 23, No. 10, 2008, pp. 1013-1016.

[2]   A. N. Fader and P. F. Escobar, “Laparoendoscopic Single-Site Surgery (LESS) in Gynecologic Oncology: Technique and Initial Report,” Gynecologic Oncology, Vol. 114, No. 2, 2009, pp. 157-161.

[3]   G. Navarra, E. Pozza, S. Occhionorelli, P. Carcoforo and I. Donini, “One-Wound Laparoscopic Cholecystectomy,” British Journal of Surgery, Vol. 84, No. 5, 1997, p. 695. 10.1002/bjs.1800840536

[4]   L. E. Ponsky, E. E. Cherullo, M. Sawyer and D. Hartke, “Single Access Site Laparoscopic Radical Nephrectomy: Initial Clinical Experience,” Journal of Endourology, Vol. 22, No. 4, 2008, pp. 663-666.

[5]   A. A. Saber, T. H. El-Ghazaly and D. B. Minnick, “Single Port Access Transumbilical Laparoscopic Roux-en-Y Gastric Bypass Using the SILS Port: First Reported Case,” Surgical Innovation, Vol. 16, No. 4, 2009, pp. 343-347.

[6]   J. A. Waters, B. M. Rapp, M. J. Guzman, A. L. Jester, D. J. Selzer, B. W. Robb, B. J. Johansen, B. M. Tsai, D. C. Maun and V. V. George, “Single-Port Laparoscopic Right Hemicolectomy: The First 100 Resections,” Diseases of the Colon & Rectum, Vol. 55, No. 2, 2012, pp. 134-139.

[7]   M. Gawart, S. Dupitron and R. Lutfi, “Laparoendoscopic Single-Site Gastric Bands versus Standard Multiport Gastric Bands: A Comparison of Technical Learning Curve Measured by Surgical Time,” The American Journal of Surgery, Vol. 203, No. 3, 2012, pp. 327-329. 2011.10.001

[8]   J. Hernandez, S. Ross, C. Morton, K. McFarlin, S. Dahal, F. Golkar, M. Albrink and A. Rosemurgy, “The Learning Curve of Laparoendoscopic Single-Site (LESS) Cholecystectomy: Definable, Short, and Safe,” Journal of the American College of Surgeons, Vol. 211, No. 5, 2010, pp. 652-657.

[9]   L. Wang, B. Liu, Z. Wu, Q. Yang, M. Hehir, W. Chen, Z. Xu, L. Xiao, F. Wang and Y. Sun, “Transumbilical Laparoendoscopic Single-Site Surgery: More than 1-Year Experience in Radical Nephrectomy and Its Learning Curve Study,” Journal of Endourology, Vol. 25, No. 2, 2011, pp. 1859-1865.

[10]   J. A. Waters, M. J. Guzman, A. D. Fajardo, D. J. Selzer, E. A. Wiebke, B. W. Robb and V. V. George, “SinglePort Laparoscopic Right Hemicolectomy: A Safe Alternative to Conventional Laparoscopy,” Diseases of the Colon & Rectum, Vol. 53, No. 11, 2010, pp. 1467-1472. 10.1007/DCR.0b013e3181f23ca0

[11]   T. Makino, J. W. Milsom and S. W. Lee, “Feasibility and Safety of Single-Incision Laparoscopic Colectomy: A Systematic Review,” Annals of Surgery, Vol. 255, No. 4, 2012, pp. 667-676.

[12]   The Clinical Outcomes of Surgical Therapy Study Group, “A Comparison of Laparoscopically Assisted and Open Colectomy for Colon Cancer,” The New England Journal of Medicine, Vol. 350, 2004, pp. 2050-2059.

[13]   B. A. Boone, P. Wagner, E. Ganchuk, L. Evans, H. J. Zeh, D. L. Bartlett and M. P. Holtzman, “Single-Incision Laparoscopic Right Colectomy in an Unselected Patient Population,” Surgical Endoscopy, Vol. 26, No. 6, 2011, pp. 1595-1601.

[14]   A. J. Senagore and C. P. Delaney, “A Critical Analysis of Laparoscopic Colectomy at a Single Institution: Lessons Learned after 1000 Cases,” The American Journal of Surgery, Vol. 191, No. 3, 2006, pp. 377-380.