Department of Surgery, University of South Florida College of Medicine, Tampa General Hospital, Tampa, FL 33601, USA.
J Am Coll Surg. 2010 Nov;211(5):652-7. doi: 10.1016/j.jamcollsurg.2010.07.008. Epub 2010 Sep 18.
The applications of laparoendoscopic single-site (LESS) surgery, including cholecystectomy, are occurring quickly, although little is generally known about issues associated with the learning curve of this new technique including operative time, conversion rates, and safety.
We prospectively followed all patients undergoing LESS cholecystectomy, and compared operations undertaken at our institutions in cohorts of 25 patients with respect to operative times, conversion rates, and complications.
One-hundred fifty patients of mean age 46 years underwent LESS cholecystectomy. No significant differences in operative times were demonstrable between any of the 25-patient cohorts operated on at our institution. A significant reduction in operative times (p < 0.001) after completion of 75 LESS procedures was, however, identified with the experience of a single surgeon. No significant reduction in the number of procedures requiring an additional trocar(s) or conversion to open operations was observed after completion of 25 LESS cholecystectomies. Complication rates were low, and not significantly different between any 25-patient cohorts.
For surgeons proficient with multi-incision laparoscopic cholecystectomy, the learning curve for LESS cholecystectomy begins near proficiency. Operative complications and conversions were infrequent and unchanged across successive 25-patient cohorts, and were similar to those reported for multi-incision laparoscopic cholecystectomy after the learning curve.
尽管人们对学习曲线相关问题，包括手术时间、中转率和安全性，知之甚少，但腹腔镜单部位手术（LESS）的应用，包括胆囊切除术，正在迅速普及。
我们前瞻性地随访了所有接受 LESS 胆囊切除术的患者，并在我们的机构中，以每 25 例患者为一组，就手术时间、中转率和并发症对手术进行了比较。
150 名平均年龄为 46 岁的患者接受了 LESS 胆囊切除术。在我们机构进行的任何一组 25 例患者中，手术时间均无显著差异。然而，当完成 75 例 LESS 手术后，发现手术时间显著缩短（p<0.001），这与一位外科医生的经验有关。完成 25 例 LESS 胆囊切除术之后，需要额外使用 trocar 或中转开放手术的手术数量并未显著减少。并发症发生率较低，且在任何 25 例患者的队列之间均无显著差异。
对于熟练掌握多孔腹腔镜胆囊切除术的外科医生而言，LESS 胆囊切除术的学习曲线在接近熟练水平时开始。手术并发症和中转发生率在连续的 25 例患者队列中没有变化，且与学习曲线后多切口腹腔镜胆囊切除术的报告相似。
