Leveling the learning curve for laparoscopic bariatric surgery

Lublin, Matthew; Lyass, Sergey; Lahmann, Brian; Cunneen, Scott A.; Khalili, Theodore M.; Elashoff, Janet D.; Phillips, Edward H

doi:10.1007/s00464-004-8201-x

Cited by 35 publications

(28 citation statements)

References 16 publications

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“…Several authors have shown that a surgeonÕs previous experience with advanced laparoscopic techniques and/or fellowship training shorten the learning curve with respect to both morbidity and operating time [1,9,12,18]. Our results strongly support these findings.…”

Section: Discussionsupporting

confidence: 83%

“…These data compare very favorably to morbidity rates seen in other series early in the learning curve. Other series have also demonstrated low rates of major morbidity early in their experience [8,9,18].…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have suggested that the learning curve is shorter for surgeons with prior development of advanced laparoscopic skills [9,18]. This topic is becoming more important as an increasing number of surgeons seek to add laparoscopic bariatric surgery to their practice.…”

mentioning

confidence: 99%

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Advanced laparoscopic skills decrease the learning curve for laparoscopic Roux-en-Y gastric bypass

2007

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Advanced laparoscopic skills decrease the learning curve for laparoscopic Roux-en-Y gastric bypass

2007

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“…Such a technique has been described in bariatric surgery -a technique of forward-chaining successfully transferred skills in stages to a surgeon with basic laparoscopic skills, to achieve competence at laparoscopic bariatric surgery with minimal morbidity and mortality (11). Although each consultant surgeon was the primary surgeon or assisting surgeon for only 50% of each case, their presence throughout allowed for continual training by observation and interaction.…”

Section: Discussionmentioning

confidence: 98%

Robotic prostatectomy: the first UK experience

Mayer

Winkler

Aggarwal

et al. 2006

Int. J. Med. Robotics Comput. Assist. Surg.

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Parameters indicative of the learning curve are comparable to existing published initial series of other robotic centres. The use of teamwork has enabled us to provide safe and time-efficient training for four surgeons simultaneously. The structured approach used in this setting demonstrates that urological surgeons of varying laparoscopic experience can acquire the skills necessary to competently perform laparoscopic radical prostatectomy.

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“…Reduction in morbidity and mortality associated with LRYGB has been shown to occur as a function of surgical experience [7][8][9]. This important issue has been recognized by the American Society for Metabolic and Bariatric Surgery (ASMBS) in its published Guidelines for Granting Privileges in Bariatric Surgery [10].…”

mentioning

confidence: 99%

Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass

et al. 2009

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Background The concept that advanced surgical training can reduce or eliminate the learning curve for complex procedures makes logical sense but is difficult to verify and has not been tested for laparoscopic Roux-en-Y gastric bypass (LRYGB). We sought to determine if minimally invasive/bariatric surgery fellowship graduates (FGs) would demonstrate complication-related outcomes (CRO) equivalent to the outcomes achieved during their training experience under the supervision of experienced bariatric surgeons. Methods We compared CRO for the first 100 consecutive LRYGBs performed in practice by five consecutive minimally invasive/bariatric fellows at new institutions (total 500 cases) to CRO for the 611 consecutive LRYGBs performed during their fellowship training experience under the supervision of three experienced bariatric surgeons at the host training institution. Results The two patient groups did not differ demographically. The 18 types of major and minor complications identified after LRYGB did not differ among the five fellowship graduates. The mentors' CRO were compatible with published benchmark data. As compared with the training institution data, the overall incidence of complications for the combined experience of fellowship graduates did not differ statistically from that of the mentors. The fellowship graduates' early experience included zero nongastrojejunostomy leaks (0% versus 1.5%) and a low rate of anastomotic stricture (0.8% versus 3.0%), incisional hernia (1% versus 4.4%), bowel obstruction (0% versus 3%), wound infection (0.3% versus 3.1%), and gastrointestinal hemorrhage (0.2% versus 1.6%). The rate of gastrojejunostomy leak (1.8% versus 2.6%) and, most importantly, mortality (0.8% versus 0.7%) did not differ between the two groups. Conclusions Fellowship graduates achieved high-quality surgical outcomes from the very beginning of their postfellowship practices, which are comparable to those of their experienced mentors. These data validate the concept that advanced surgical training can eliminate the learning curve often associated with complex minimally invasive procedures, specifically LRYGB.

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Leveling the learning curve for laparoscopic bariatric surgery

Abstract: By transferring skills in stages, a laparoscopic bariatric program can be established with minimal morbidity and mortality.

Cited by 35 publications

References 16 publications

Advanced laparoscopic skills decrease the learning curve for laparoscopic Roux-en-Y gastric bypass

Advanced laparoscopic skills decrease the learning curve for laparoscopic Roux-en-Y gastric bypass

Robotic prostatectomy: the first UK experience

Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass

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