Laparoscopic colorectal surgery |
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Authors: | F Agachan J S Joo M Sher E G Weiss J J Nogueras S D Wexner |
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Institution: | (1) Department of Colorectal Surgery, Cleveland Clinic Florida, 3000 W. Cypress Creek Road, Ft. Lauderdale, FL 33309-1743, USA, US |
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Abstract: | Background: A variety of parameters can affect the outcome of laparoscopic colorectal surgery. All consecutive laparoscopic colorectal
procedures (LCP) were analyzed in an attempt to define an operative time curve for different categories of procedures. Additionally,
impacts of case number and procedure type on length of procedure were assessed.
Methods: Our computerized data system was reviewed for all patients who underwent LCP in a 4-year period. Parameters reviewed included
age, sex, surgical indications, procedures performed, length of procedure, intraoperative and postoperative complications,
incidence and causes for conversion, duration of postoperative ileus, and hospital stay.
Results: Between August 1991 and December 1995, 175 patients with a mean age of 48.4 (range 15–88) years underwent LCP. Patients were
divided chronologically into five consecutive groups. Procedures were classified as either basic or complex. Complex procedures
were those in which there was either a fixed tumor, an abscess or fistula, or extensive intraabdominal adhesions from prior
surgery. Complex procedures performed each year ranged from 37% to 66%. As well, the percentage of patients with adhesions
increased from 17% in 1991 to 29% in 1995. Despite increased difficulty, the intraoperative complication rate fell significantly
from 29% in 1991 to 8% in 1995 (p < 0.005). Additionally, the operative length decreased from a mean of 201 min in 1991 to a mean of 141 min in 1995 (p < 0.05).
Conclusion: The rapid improvement in these parameters may reflect both ascents in the learning curve and change in type of procedure.
Adhesions, due to prior surgery or inflammation making dissection tedious, is the most important technical factor which effects
operation time (p < 0.001). However, despite increased complexity, operating time decreased, reflecting improved skills. Thus, the experienced
laparoscopic surgeon can increase the spectrum of applications with expectations of shorter operations and lower complication
rates.
Received: 14 March 1996/Accepted: 31 July 1996 |
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Keywords: | : Laparoscopy — Colorectal surgery — Operative time — Learning curve |
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