Learning Curve of Laparoscopic Colorectal Resections
Conditions
Brief summary
Laparoscopic colorectal surgery has been widely accepted worldwide; however, despite the well-known benefits and comparable oncological outcomes, it is still limited by a lack of tactile sensation and a reduced operative field view. In addition, the inconsistency in the number and course of the mesenteric vessels significantly influences the learning curve with 30 to 70 cases required for proficiency. To overcome these limitations, the vascular anatomy can be mapped using CT-angiography, and the images can be processed with rendering software to reconstruct a three-dimensional model of the mesenteric vessels. The aim of this study was to assess the influence of visualizing the three-dimensional vascular anatomy on the learning curve for laparoscopic colorectal surgery.All patients who underwent laparoscopic left or right hemicolectomies between January 2012 and January 2014 were evaluated for inclusion in this study. To assess the influence of preliminary knowledge of colonic vascular anatomy on the learning curve, we considered 2 groups of two surgeons with different levels of experience. In the first group (group A), the surgeons were able to view 3D reconstructions before and during the surgery, while the surgeons in Group B were only able to view the 3D reconstructions after surgery.
Interventions
PROCEDUREmulti-slice Computed Tomography angiography and three-dimensional reconstruction software
Sponsors
University of Roma La Sapienza
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients in which standard laparoscopic right or left hemicolectomy was planned
Exclusion criteria
* patients who underwent extended right hemicolectomy and segmental colectomy or sigmoidectomy and patients for whom the surgical technique was modified intraoperatively * patients who underwent anterior rectal resection and emergency procedures for complicated diverticulitis were excluded because these procedures require higher technical skills. * Patients who had an ASA score of IV, a BMI over 40 or contraindications for laparoscopy were also excluded.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| operating time | operating time |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| intraoperative and postoperative complications | first 2 week after surgery | — |
| hospital stay | first 2 weeks after surgery | — |
| oncological clearance | first 2 weeks after surgery | radicality and number of harvested lymph nodes |
Countries
Italy
Outcome results
None listed