Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Aug 28, 2009; 15(32): 4005-4008
Published online Aug 28, 2009. doi: 10.3748/wjg.15.4005
Reaching proficiency in laparoscopic splenectomy
Tarik Zafer Nursal, Ali Ezer, Sedat Belli, Alper Parlakgumus, Kenan Caliskan, Turgut Noyan
Tarik Zafer Nursal, Ali Ezer, Sedat Belli, Alper Parlakgumus, Kenan Caliskan, Turgut Noyan, Department of General Surgery, University of Baskent, Dadaloglu Mah., 01200, Serin Evler 39. Sk. No. 6 Yüregir/Adana, Turkey
Author contributions: Nursal TZ and Ezer A contributed equally to this work; Nursal TZ, Ezer A, Belli S, Parlakgumus A, Caliskan K and Noyan T designed the research; Nursal TZ performed the research and analyzed the data; Caliskan K, Noyan T, Belli S contributed analytic tools; Nursal TZ and Ezer A wrote the paper.
Correspondence to: Dr. Ali Ezer, Department of General Surgery, University of Baskent, Dadaloglu Mah., 01200, Serin Evler 39. Sk. No. 6 Yüregir/Adana, Turkey. draliezer@yahoo.com
Telephone: +90-535-9661344
Fax: +90-322-3271273
Received: June 2, 2009
Revised: July 10, 2009
Accepted: July 17, 2009
Published online: August 28, 2009
Abstract

AIM: To investigate the proficiency level reached in laparoscopic splenectomy using the learning curve method.

METHODS: All patients in need of splenectomy for benign causes in whom laparoscopic splenectomy was attempted by a single surgeon during a time period of 6 years were included in the study (n = 33). Besides demographics, operation-related variables and the response to surgery were recorded. The patients were allocated to groups of five, ranked according to the date of the operation. Operation duration, complications, postoperative length of stay, conversion to laparotomy and splenic weight were then compared between these groups.

RESULTS: There was a significant difference regarding operation times between the groups (P = 0.001). An improvement was observed after the first 5 cases. The learning curve was flat up to the 25th case. Following the 25th case the operation times decreased still further. There was no difference between the groups regarding the other parameters.

CONCLUSION: Unlike the widely accepted “L” shape, the learning curve for laparoscopic splenectomy is a horizontal lazy “S” with two distinct slopes. Privileges may be granted after the first 5 cases. However proficiency seems to require 25 cases.

Keywords: Laparoscopic splenectomy; Education; Learning curve; Hematology; Proficiency