The learning curve of single-port laparoscopic appendectomy performed by emergent operation
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RESEARCH ARTICLE
Open Access
The learning curve of single-port laparoscopic appendectomy performed by emergent operation YongHun Kim1 and WooSurng Lee2*
Abstract Background: Single-port laparoscopic appendectomy (SPLA) has the advantage of minimizing abdominal incision scars with patient satisfaction. However, it has the following disadvantages: it provides a narrower surgical field than conventional laparoscopic appendectomy, which requires a considerably longer operative time to achieve surgical skills. This study was conducted to evaluate the learning curve for SPLA. Methods: This study included a total of 120 patients with acute abdomen who visited our emergency department and were diagnosed with acute appendicitis between March 2013 and February 2015. They underwent SPLA by a single surgeon. Patients were divided into 4 groups of 30 patients each according to operation dates. Operative time, time to resume oral intake, length of hospital stay, and postoperative complications were analyzed. Results: The mean operative time was 59.9 ± 19.9 min. It was shortened after completion of 30 operations and remained unchanged until it was further shortened after completion of 90 operations. There was no significant difference in time to resumption of oral intake or length of hospital stay between the 4 groups. Postoperative complications occurred in 18 patients, but the frequency of the complications was not significantly different between the 4 groups. Conclusions: The results of this study suggest that surgeons can achieve surgical skills for SPLA after completion of 30 operations and more experienced surgical skills by SPLA successfully after completion of 90 operations. Keywords: Learning curve, Laparoscopy, Appendectomy, Emergencies
Background Laparoscopic appendectomy is minimally invasive compared to conventional open appendectomy and has the advantages of decreased postoperative pain, shortened hospital stay, fewer postoperative complications, and better cosmesis. It has replaced conventional open appendectomy in the treatment of acute appendicitis [1, 2]. Therefore, this laparoscopic appendectomy is currently the gold standard operation for acute appendicitis and provides similar surgical outcomes as conventional open appendectomy, even in cases of complicated appendicitis [3]. Recently, advances in laparoscopic instruments and optical systems enabled surgeons to perform intra* Correspondence: [email protected] 2 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, 82, Gugwon-daero, Chungju-si, Chungbuk, Republic of Korea Full list of author information is available at the end of the article
abdominal operation through a single incision around the umbilicus; in particular, single-port laparoscopic appendectomy (SPLA), which minimizes visible scars in the abdominal wall, satisfies patients [4, 5]. In addition, previous randomized controlled studies reported that SPLA has surgical outcomes similar to those of threeport laparoscopic app
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