How to reach proficiency in laparoscopic splenectomy?

Laparoscopic splenectomy has become the gold standard intervention for the removal of the spleen, especially for benign causes. However, the organ’s high anatomic location, fragility and generous blood supply makes the procedure an advanced laparoscopic operation. Furthermore, unlike patients with gall bladder stones, patients who need splenectomy for benign disorders are rare. These factors may prohibit the laparoscopic surgeon from becoming proficient in laparoscopic splenectomy. Measuring the expertise and setting a minimum number of procedures needed to be performed in order to be accepted as proficient in this rather rare operation has proved difficult.

A research team, led by Dr. Tarik Z. Nursal from the University of Baskent, has investigated the proficiency level reached in laparoscopic splenectomy procedures using the learning curve method. Their study will be published on August 28, 2009 in the World Journal of Gastroenterology.

In this study, 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. 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.

They found that unlike the widely accepted “L” shape, the learning curve for laparoscopic splenectomy was a horizontal lazy “S” with two distinct slopes. With the first 5 cases the novice may be granted privileges for performing laparoscopic splenectomy on an individual basis. Past the 25th case the surgeon could be accepted as an expert in the field.

Reference: Nursal TZ, Ezer A, Belli S, Parlakgumus A, Caliskan K, Noyan T. Reaching proficiency in laparoscopic splenectomy. World J Gastroenterol 2009; 15(32): 4005-4008

http://www.wjgnet.com/1007-9327/15/4005.asp

Correspondence to: Dr. Ali Ezer, Department of General Surgery, University of Baskent, Dadaloglu Mah., 01200, Serin, Evler 39. Sk. No. 6 Yüregir/Adana, Turkey.

About World Journal of Gastroenterology

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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