Feinberg Elyssa J, Agaba Emmanuel, Feinberg Michelle L, Camacho Diego, Vemulapalli Pratibha
Montefiore Medical Center/Albert Einstein College of Medicine, NY, USA.
Surg Laparosc Endosc Percutan Tech. 2012 Apr;22(2):114-7. doi: 10.1097/SLE.0b013e31824799ef.
Single-incision laparoscopic surgery (SILS) is laparoscopic surgery done by one incision through the umbilicus. Cholecystectomy lends itself well to a SILS approach. As these procedures have become more widely adapted, it is important to determine the approximate learning curve to decrease two surgical endpoints: (1) time to completion of the procedure; and (2) decreased incidence of conversion.
We prospectively reviewed our series of 50 cholecystectomies done using the SILS approach between May 2008 to September 2008. All cases were performed by two advanced laparoscopic surgeons at a single institution. Data was collected immediately after the case and entered into an Excel database. Cases were performed by insufflating the abdomen with a Veress needle through the umbilicus followed by placement of 5-mm ports at the umbilicus.
Patient ages ranged between 21 and 82 years with a median age of 45 years. Body mass index (BMI) range was 21 to 42 kg/m with a mean of 30 kg/m. Average length of time for cases was 1 hour 9 minutes with a range between 55 minutes and 120 minutes. The average length of time for the first 25 cases was 80 minutes. When compared with cases 26 to 50 the average length of time was 60 minutes (P<0.05). The conversion rate to conventional laparoscopic cholecystectomy was 10%. Conversion was accomplished through the addition of a 5-mm port elsewhere on the abdominal cavity. After the tenth case, the incidence of conversion went down to zero. When conversions were further stratified, they occurred within each individual surgeon's first ten cases.
The learning curve for successful consistent completion of SILS cholecystectomy cases appears to be after 25 cases. In addition, conversion rates drop dramatically after the first ten cases.
单孔腹腔镜手术（SILS）是通过脐部一个切口进行的腹腔镜手术。胆囊切除术非常适合采用SILS方法。随着这些手术方法得到更广泛的应用，确定大致的学习曲线以降低两个手术终点非常重要：（1）手术完成时间；（2）降低中转率。
我们前瞻性地回顾了2008年5月至2008年9月间采用SILS方法进行的50例胆囊切除术。所有病例均由同一机构的两名高级腹腔镜外科医生完成。病例完成后立即收集数据并录入Excel数据库。手术通过经脐部Veress针向腹腔充气，然后在脐部放置5毫米端口进行。
患者年龄在21岁至82岁之间，中位年龄为45岁。体重指数（BMI）范围为21至42kg/m²，平均为30kg/m²。病例平均时长为1小时9分钟，范围在55分钟至120分钟之间。前25例的平均时长为80分钟。与第26至50例相比，平均时长为60分钟（P<0.05）。中转至传统腹腔镜胆囊切除术的比例为10%。中转是通过在腹腔其他部位增加一个5毫米端口完成的。在第10例之后，中转发生率降至零。当进一步对中转情况进行分层时，发现它们发生在每位外科医生的前10例手术中。
成功持续完成SILS胆囊切除病例的学习曲线似乎在25例之后。此外，在前10例之后中转率大幅下降。
