The Learning Curve Of Hand-assisted Laparoscopic Surgery For Rectal Cancer

Objective:To define a learning curve for hand-assisted laparoscopic surgery through retrospective analysis of surgical experience and outcomes on 160 cases of rectal cancer.Methods:A retrospective analysis of prospectively recorded data was performed in The First Affiliated Hospital, College of Medicine, ZheJiang University, from May 2009 to April 2012.160 cases HALS for recatal cancer performed by a single surgeon was included. They were analyzed as 8 consecutive equal cohorts. Operative time and quality-related outcomes, including, intraoperatve blood loss, conversions, operative and postoperative complications, counts of lymph nodes, length of stay and reoperations were compared in each cohort of 20 cases.Results:There were no significant differences among the 8 cohorts in terms of sex, age, proctectomy type, pTNM staging, intraoperative blood loss, length of stay or first bowel movement(P>0.05). Mean overall operative time decreased from No.2 cohort (P<0.05). Mean overall counts of lymph nodes increased(P<0.05).The ratio of cases which lymph nodes counts was less than 12 were similar (P>0.05), but cohort No.5-No.8 was much less than No.1-No.4 in absolute value(12.1% v.s 43.8%,P=0.001).3 conversions (1.9%), including 2 intraoperative complications(1.3%) of an anastomotic leakage case in No.3 and a bleeding case in No.4 cohort and the No.l case with adhesion, were happened.4 postoperative complications (2.5%) including 2 reoperations(1.3%) were happened. No deaths.Conclusion:HALS for rectal cancer has its learning curve with 20 cases to master preliminarily and 80 cases to proficiency.