Annals of Coloproctology

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Minimally invasive surgery

Learning curve for single-port robot-assisted colectomy: Moon Suk Choi, Seong Hyeon Yun, Sung Chul Lee, Jung Kyong Shin, Yoon Ah Park, Jungwook Huh, Yong Beom Cho, Hee Cheol Kim, Woo Yong Lee; Ann Coloproctol. 2024;40(1):44-51. Published online December 20, 2022; DOI: https://doi.org/10.3393/ac.2022.00745.0106

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Purpose
Since the introduction of robotic surgery, robots for colorectal cancer have replaced laparoscopic surgery, and a single-port robot (SPR) platform has been launched and is being used to treat patients. We analyzed the learning curve and initial complications of using an SPR platform in colorectal cancer surgery.
Methods
We reviewed 39 patients who underwent SPR colectomy from April to October 2019. All surgeries were performed by the same surgeon using an SPR device. A learning curve was generated using the cumulative sum methodology to assess changes in total operation time, docking time, and surgeon console time. We grouped the patients into 3 groups according to the time period: the first 11 were phase 1, the next 11 were phase 2, and the last 17 were phase 3.
Results
The mean age of the patients was 61.28±13.03 years, and they had a mean body mass index of 23.79±2.86 kg/m2. Among the patients, 23 (59.0%) were male, and 16 (41.0%) were female. The average operation time was 186.59±51.30 minutes, the average surgeon console time was 95.49±35.33 minutes, and the average docking time (time from skin incision to robot docking) was 14.87±10.38 minutes. The surgeon console time differed significantly among the different phases (P<0.001). Complications occurred in 8 patients: 2 ileus, 2 postoperation hemoglobin changes, 3 urinary retentions, and 1 complicated fluid collection.
Conclusion
In our experience, the learning curve for SPR colectomy was achieved after the 18th case.

Citations

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A systematic review of the Da Vinci® Single-Port system (DVSP) in the context of colorectal surgery
Francesco Brucchi, Isacco Montroni, Roberto Cirocchi, Giovanni Taffurelli, Marco Vitellaro, Gianluca Mascianà, Giovanni Battista Levi Sandri, Gianlorenzo Dionigi, Sara Lauricella
International Journal of Colorectal Disease.2025;[Epub] CrossRef
Assessing the learning curve in robot-assisted intracorporeal colorectal anastomosis and transrectal extraction (NICE) procedure: from Initial Learning to Mastery
Jacques Bistre-Varon, Muhammed Elhadi, Robert Wei, Jimena Alcocer-Barrios, Ryan Gunter, Joshua Coursey, Priya Prakash, Erin McAtee, Haley Lanser, Rachel Ellsworth, Matthew Weaver, Jean-Paul LeFave, Eric M. Haas
Journal of Robotic Surgery.2025;[Epub] CrossRef
Short-term outcomes of single-port robotic surgery versus single-port laparoscopic surgery for colon cancer: a multicenter matched-cohort analysis
Gyoung Tae Noh, Young Il Kim, Seung Ho Song, Hye Jin Kim, Song-Soo Yang, Yong Sik Yoon, Ji Hoon Kim, Hyung Jin Kim, Byung Mo Kang, Chang Woo Kim, Suk-Hwan Lee, Jun Gi Kim, Yoon Suk Lee
Surgical Endoscopy.2025; 39(12): 8444. CrossRef
Application of the Da Vinci Single‐Port (SP) Robot in General Surgery: A First Systematic Review
Antonio Cubisino, Maurice Chazal, Fabrizio Panaro
The International Journal of Medical Robotics and Computer Assisted Surgery.2025;[Epub] CrossRef
Da Vinci single-port robotic system current application and future perspective in general surgery: A scoping review
Francesco Celotto, Niccolò Ramacciotti, Alberto Mangano, Giacomo Danieli, Federico Pinto, Paula Lopez, Alvaro Ducas, Jessica Cassiani, Luca Morelli, Gaya Spolverato, Francesco Maria Bianco
Surgical Endoscopy.2024; 38(9): 4814. CrossRef
Wristed articulated instrumentation for single‐incision plus one‐port laparoscopic surgery for obstructed sigmoid colon cancer—A video vignette
Sung Uk Bae
Colorectal Disease.2024; 26(9): 1782. CrossRef
Evaluation of the da Vinci single-port system in colorectal cancer surgery: a scoping review
Arcangelo Picciariello, Alfredo Annicchiarico, Gaetano Gallo, Agnese Dezi, Ugo Grossi
Updates in Surgery.2024; 76(7): 2515. CrossRef

Minimally invasive surgery,Surgical technique

The impact of assistants’ reverse alignment surgical skill proficiency on laparoscopic colorectal surgery: Seunghun Lee; Ann Coloproctol. 2022;38(6):432-441. Published online January 20, 2022; DOI: https://doi.org/10.3393/ac.2021.00689.0098

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Graphical Abstract Abstract PDF

Purpose
We aimed to investigate the difference in the surgical outcome based on whether the assistant overcame the mirror image in laparoscopic colorectal surgery.
Methods
Three hundred patients who underwent laparoscopic colorectal surgery performed by single operator were divided into 2 groups. Based on the assistants’ experience, patients who underwent surgery involving 1 of 6 residents with an experience of fewer than 30 surgeries each were classified into group 1. Patients who underwent surgery involving a single fellow as an assistant with an experience of over 1,000 surgeries were classified into group 2. According to the type of surgery, patients were divided into left and right colon resection groups and the surgical outcome of groups 1 and 2 was investigated.
Results
Group 2 exhibited shorter operation time, less bleeding, shorter postoperative hospital stay, lower open conversion, and anastomotic leakage rate than group 1. In right colon resection, the operation time was shorter in group 2. In left colon resection, group 2 exhibited shorter operation time, less bleeding, shorter postoperative hospital stay, and lower anastomotic leakage rate. In the multivariate analysis, the assistant was a factor affecting the operation time in the entire surgery.
Conclusion
Assistants’ reverse alignment surgical skill proficiency was a factor affecting the operation time.

Citations

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The Impact of the First Assistant’s Experience on the Perioperative Outcome of Patients Undergoing Laparoscopic Hysterectomies for Benign Diseases: A Retrospective Analysis
Sangam Jha, Vikas Chandra Jha, Sharda Jha, Jafeesha B. Singh
Journal of Gynecologic Surgery.2025; 41(4): 164. CrossRef
Design of Automatic Tool Replacement Mechanism for Laparoscopic Surgical Robot Arm for Solo Surgery
Daehwan Ko, Yeonkyoung Kim, Hongseok Lim, Sungmin Kim
The International Journal of Medical Robotics and Computer Assisted Surgery.2025;[Epub] CrossRef
Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
Chungyeop Lee, In Ja Park
The World Journal of Men's Health.2024; 42(2): 304. CrossRef
Can assistants’ skills be used to improve colorectal cancer surgery outcomes in a way similar to the “butterfly effect”?
Je-Ho Jang
Annals of Coloproctology.2022; 38(6): 391. CrossRef

Benign GI diease

Resident Learning Curve for Laparoscopic Appendectomy According to Seniority: Chang Woo Kim, Sook Young Jeon, Bomina Paik, Jun Woo Bong, Sang Hyun Kim, Suk-Hwan Lee; Ann Coloproctol. 2020;36(3):163-171. Published online February 14, 2020; DOI: https://doi.org/10.3393/ac.2019.07.20

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Abstract PDF

Purpose
To delineate the learning curve (LC) for laparoscopic appendectomy (LA) performed by residents according to seniority in training.
Methods
Between October 2015 and November 2016, 150 patients underwent LA by three residents (in their first, second, and third year of training) under supervision. The patients were non-randomly assigned to each resident. The data were reviewed and analyzed retrospectively from prospectively collected database. The perioperative outcomes were compared between the three residents including operation time, complication, conversion, and so on. The LCs were evaluated by the moving average method and cumulative sum control chart (CUSUM) for operation time and surgical completion.
Results
Baseline characteristics and perioperative outcomes were similar except for age and location of the appendix among the three groups. Operation time was not different among the three residents (43.9, 45.3, and 48.4 min for A, B, and C, respectively). The moving average method for operation time showed a decreasing tendency for all residents. CUSUM for operation time showed that the peak points occurred at the 24th, 18th, and 31st cases for resident A, B, and C, respectively. In terms of surgical failure, residents A, B, and C reached steady states after the 35th, 11th, and 16th cases, respectively. Perforation of the appendix base was the only risk factor for surgical failure.
Conclusion
The LC for LA by residents was 11-35 cases according to multidimensional statistical analyses. The accumulation of surgical experience of residents might affect the LC, especially for surgical completion rather than for operation time.

Citations

Citations to this article as recorded by

Comparative analysis of surgical outcomes of laparoscopic appendectomy performed by six surgeons with different subspecialties: a retrospective cohort study using risk-adjusted cumulative summation
Ji Hyeong Song, Inyoung Na, Song-Yi Kim, Youn Ju Lee, Sun Jong Han, Sang Il Youn, Sa-Hong Min, Jin Soo Kim
Annals of Surgical Treatment and Research.2025; 109(3): 207. CrossRef
The Influence of Surgical Teaching on Laparoscopic Cholecystectomy Outcomes: A Retrospective Propensity Score-Matched National Cohort Study
Joana Rodrigues Ribeiro, André Silva Alves, Pascal Probst, Samuel A. Käser, Christian Toso, Beat Moeckli
Journal of Surgical Education.2025; 82(11): 103744. CrossRef
Systematic review and meta-analysis comparing perioperative outcomes of emergency appendectomy performed by trainee vs trained surgeon
Theophilus TK. Anyomih, Thomas Jennings, Alok Mehta, J Robert O'Neill, Ioanna Panagiotopoulou, Stavros Gourgiotis, Elizabeth Tweedle, John Bennett, R Justin Davies, Constantinos Simillis
The American Journal of Surgery.2023; 225(1): 168. CrossRef
Graded operative autonomy in emergency appendectomy mirrors case-complexity: surgical training insights from the SnapAppy prospective observational study
Nathalie Young, Rebecka Ahl Hulme, Maximilian Peter Forssten, Lewis Jay Kaplan, Thomas Noel Walsh, Yang Cao, Shahin Mohseni, Gary Alan Bass, Alan Biloslavo, Hayato Kurihara, Isidro Martinez-Casas, Jorge Pereira, Arvid Pourlotfi, Éanna J. Ryan, Matti Tolon
European Journal of Trauma and Emergency Surgery.2023; 49(1): 33. CrossRef
Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper
Nicola de’Angelis, Francesco Marchegiani, Carlo Alberto Schena, Jim Khan, Vanni Agnoletti, Luca Ansaloni, Ana Gabriela Barría Rodríguez, Paolo Pietro Bianchi, Walter Biffl, Francesca Bravi, Graziano Ceccarelli, Marco Ceresoli, Osvaldo Chiara, Mircea Chiri
World Journal of Emergency Surgery.2023;[Epub] CrossRef
How does the number of training years in pediatric surgery affect appendectomy outcomes?
Carlos Delgado-Miguel, Miriam Miguel-Ferrero, María San Basilio, Carla Ramírez, Juan Camps, Francisco Hernández Oliveros
Pediatric Surgery International.2023;[Epub] CrossRef
Clinical outcomes of locking polymeric clip for laparoscopic appendectomy in patients with appendicitis: a retrospective comparison with loop ligature
Seokwon Kim, Byong Ho Jeon, Sang Sik Cho, Ui Sup Shin, Sun Mi Moon
Annals of Coloproctology.2022; 38(2): 160. CrossRef
Laparoscopic appendicectomy without the use of disposable materials - a low-cost alternative - 1,552 cases operated in 20 years
CARLOS EDUARDO DOMENE, PAULA VOLPE, ANDRÉ VALENTE SANTANA
Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub] CrossRef
Learning curve in laparoscopic appendectomy: training strategy of laparoscopic surgery
Hyung Ook Kim
Annals of Coloproctology.2022; 38(3): 276. CrossRef
Factors Influencing the Difficulty and Need for External Help during Laparoscopic Appendectomy: Analysis of 485 Procedures from the Resident-1 Multicentre Trial
Stefano Cioffi, Andrea Spota, Michele Altomare, Stefano Granieri, Roberto Bini, Francesco Virdis, Federica Renzi, Elisa Reitano, Osvaldo Chiara, Stefania Cimbanassi
Journal of Personalized Medicine.2022; 12(11): 1904. CrossRef
Impact of COVID-19 on the care of acute appendicitis: a single-center experience in Korea
Chang Woo Kim, Suk-Hwan Lee
Annals of Surgical Treatment and Research.2021; 101(4): 240. CrossRef

Learning Curve for a Laparoscopic Appendectomy by a Surgical Trainee: Song Yi Kim, Sung Gun Hong, Hye Rin Roh, Seong Bae Park, Yang Hee Kim, Gi Bong Chae; J Korean Soc Coloproctol. 2010;26(5):324-328. Published online October 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.5.324

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Abstract PDF

Purpose

The laparoscopic appendectomy has been a basic part of the principal of a more complex laparoscopic technique for the surgical trainee. As the number of laparoscopic appendectomies performed by surgical trainees has increased, we are trying to check the stability of, which is controversial, and the learning curve associated with a laparoscopic appendectomy.

Methods

We studied the demographics, histologic diagnoses, operative time, the number of complicated cases, and hospital duration of one hundred and three patients who underwent an open appendectomy (group A, 53) or a laparoscopic appendectomy (group B, 50) retrospectively through a review of their medical records. The learning curve for the laparoscopic appendectomy was established through the moving average and ANOVA methods.

Results

There were no differences in the operative times (A, 64.15 ± 29.88 minutes; B, 58.2 ± 20.72 minutes; P-value, 0.225) and complications (A, 11%; B, 6%; P-value, 0.34) between group A and group B. Group B was divided into group C who underwent the operation in the early period (before the learning curve) and group D who underwent the operation in the later period (after the learning curve). The average operative time for group C was 66.83 ± 21.55 minutes, but it was 45.25 ± 10.19 minutes for group D (P-value < 0.0001). Although this difference was statistically significant, no significant difference in the complication rate was observed between the two groups.

Conclusion

A laparoscopic appendectomy, compared with an open appendectomy, performed by a surgical trainee is safe. In this study, the learning curve for a laparoscopic appendectomy was thirty cases.

Citations

Citations to this article as recorded by

Factors prolonging the operative time for transumbilical laparoscopic-assisted appendectomy in pediatric patients: a retrospective single-center study
Yohei Sanmoto, Yudai Goto, Kazuki Shirane, Akio Kawami, Kouji Masumoto
Surgery Today.2025; 55(1): 110. CrossRef
A six-step approach to easy Endoloop® application during laparoscopic appendicectomy
JQI Lim, A Dosis, M Lim
The Annals of The Royal College of Surgeons of England.2024;[Epub] CrossRef
Trial of an Inexpensive Training Simulation Model for Laparoscopic Appendicectomy
Anjana S Kumar, Sendhil Rajan, Adeline Rankin, Mina Youssef
Cureus.2024;[Epub] CrossRef
Routine use of laparoscopic techniques in daily practice improves outcomes after appendectomy
Tiia Mönttinen, Helmi Kangaspunta, Johanna Laukkarinen, Mika Ukkonen
European Journal of Trauma and Emergency Surgery.2023; 49(4): 1763. CrossRef
Graded operative autonomy in emergency appendectomy mirrors case-complexity: surgical training insights from the SnapAppy prospective observational study
Nathalie Young, Rebecka Ahl Hulme, Maximilian Peter Forssten, Lewis Jay Kaplan, Thomas Noel Walsh, Yang Cao, Shahin Mohseni, Gary Alan Bass, Alan Biloslavo, Hayato Kurihara, Isidro Martinez-Casas, Jorge Pereira, Arvid Pourlotfi, Éanna J. Ryan, Matti Tolon
European Journal of Trauma and Emergency Surgery.2023; 49(1): 33. CrossRef
Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper
Nicola de’Angelis, Francesco Marchegiani, Carlo Alberto Schena, Jim Khan, Vanni Agnoletti, Luca Ansaloni, Ana Gabriela Barría Rodríguez, Paolo Pietro Bianchi, Walter Biffl, Francesca Bravi, Graziano Ceccarelli, Marco Ceresoli, Osvaldo Chiara, Mircea Chiri
World Journal of Emergency Surgery.2023;[Epub] CrossRef
Development of long-term courses in minimally invasive surgery training for the acquisition and retention of laparoscopic skills
Cecilia Gigena, Carolina Millan
Journal of Pediatric Surgery Open.2023; 3: 100055. CrossRef
Development of a rating scale for objective assessment of performance in laparoscopic appendicectomy surgery
Pramudith Sirimanna, Stephen Boyce, Prashanth Gunanayagam, Marc A. Gladman, Vasi Naganathan
ANZ Journal of Surgery.2022; 92(7-8): 1724. CrossRef
Bladder injury during laparoscopic appendectomy: Detection, management, and learning point for surgical trainees
Joseph Xavier, Cecile T Pham, Hock Cheah, Kenneth Wong, Shannon Di Lernia
Surgery in Practice and Science.2022; 9: 100075. CrossRef
A multilevel, step-based model to evaluate progress in procedure efficiency for laparoscopic appendicectomy in surgical training: structured evaluation using ‘ebb-and-flow’ and ‘string-of-pearls’ concepts
Kjetil Søreide, Benedicte Skjold-Ødegaard
BJS Open.2022;[Epub] CrossRef
Learning curve in laparoscopic appendectomy: training strategy of laparoscopic surgery
Hyung Ook Kim
Annals of Coloproctology.2022; 38(3): 276. CrossRef
Intra and Postoperative Advantages of Laparoscopy in the Treatment of Complicated Appendicitis
Andrej Nikolovski, Cemal Ulusoy
PRILOZI.2022; 43(2): 59. CrossRef
Feasibility of safe laparoscopic surgery performed by junior residents without exposure of open appendectomy: A retrospective study
Satya Prakash Meena, Mayank Badkur, Mahaveer S. Rodha, Mahendra Lodha, Ashok Puranik, Krashan Kant Premi
Journal of Family Medicine and Primary Care.2022; 11(2): 581. CrossRef
Laparoscopic Appendectomy Performed by Surgical Interns: Is it Too Early?
Agustin C. Valinoti, Nicolas H. Dreifuss, Cristian A. Angeramo, Francisco Schlottmann
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2021; 31(2): 223. CrossRef
Deciphering the inflection points to achieve proficiency for each procedure step during training in laparoscopic appendicectomy
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Mastering the learning curve significantly reduces operative time for laparoscopic treatment of complicated appendicitis
Andrej Nikolovski, Aleksandar Otljanski, Rexhep Seljmani, Svetozar Antovic, Nikola Jankulovski
Archives of Public Health.2021; 13(2): 96. CrossRef
Operative duration-based learning period analysis for reverse and total shoulder arthroplasty: A multicenter study
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Shoulder & Elbow.2020; 12(1_suppl): 23. CrossRef
A clinical comparison of laparoscopic versus open appendectomy for the treatment of complicated appendicitis: historical cohort study
Tomoya Takami, Tomoyuki Yamaguchi, Hiroyuki Yoshitake, Kotaro Hatano, Naoki Kataoka, Masafumi Tomita, Shinichiro Makimoto
European Journal of Trauma and Emergency Surgery.2020; 46(4): 847. CrossRef
Video Coaching Improving Contemporary Technical and Nontechnical Ability in Laparoscopic Education
Chien-Hung Liao, Chun-Hsiang Ooyang, Chih-Chi Chen, Chien-An Liao, Chi-Tung Cheng, Ming-Ju Hsieh, Chi-Hsun Hsieh, Chun-Yi Tsai, Ta-Sen Yeh, Chun-Nan Yeh, Chih-Yuan Fu
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Safety assessment of open appendectomies for complicated acute appendicitis in children: a comparison of trainees and specialists
George Vaos, Nick Zavras, Anastasia Dimopoulou, Emmanouil Iakomidis, George Pantalos, Alexander Passalides
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AUDIT OF LAPAROSCOPIC APPENDICECTOMY IN A SURGICAL UNIT.

Indian Journal of Medical Research and Pharmaceutical Sciences.2020; 7(12): 1. CrossRef
Resident Learning Curve for Laparoscopic Appendectomy According to Seniority
Chang Woo Kim, Sook Young Jeon, Bomina Paik, Jun Woo Bong, Sang Hyun Kim, Suk-Hwan Lee
Annals of Coloproctology.2020; 36(3): 163. CrossRef
The operational ramifications of a vascular surgical fellowship
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Can laparoscopic appendectomy be safely performed by surgical residents without prior experience of open appendectomy?
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Initial Experience with Single Incision Laparoscopic Appendectomy by Surgical Resident
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Development of a proficiency‐based virtual reality simulation training curriculum for laparoscopic appendicectomy
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Effect of Resident Involvement on Operative Time and Operating Room Staffing Costs
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The learning curve of single-port laparoscopic appendectomy performed by emergent operation
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World Journal of Emergency Surgery.2016;[Epub] CrossRef
Learning curve after rapid introduction of laparoscopic appendectomy: are there any risks in surgical resident participation?
Eszter Mán, Tibor Németh, Tibor Géczi, Zsolt Simonka, György Lázár
World Journal of Emergency Surgery.2016;[Epub] CrossRef
TULAA: A Minimally Invasive Appendicectomy Technique for the Paediatric Patient
Giordano Perin, Maria Grazia Scarpa
Minimally Invasive Surgery.2016; 2016: 1. CrossRef
Laparoscopic appendicectomy: an operation for all trainees but does the learning curve continue into consultanthood?
David Mackrill, Stephen Allison
ANZ Journal of Surgery.2015; 85(5): 349. CrossRef
Conventional Laparoscopic Appendicectomy and Laparoscope-Assisted Appendicectomy: a Comparative Study
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Evolution of Minimally Invasive Techniques Within an Academic Surgical Practice at a Single Institution
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Laparoscopic Appendectomy: Is There a Learning Curve after Completion of Colorectal Fellowships Training?
Seung Hyun Lim, Jeonghyun Kang, Younghae Song, Im-kyung Kim
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The impact of regional reconfiguration on the management of appendicitis
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The Learning Curve for the Laparoscopic Approach for Colorectal Cancer: A Single Institution's Experience
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Arthroscopic repair of large rotator cuff tears using the double-row technique: an analysis of surgeon experience on efficiency and outcomes
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A Clinical Comparison of Laparoscopic versus Open Appendectomy for Complicated Appendicitis
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Initial Experiences with a Laparoscopic Colorectal Resection: a Comparison of Short-term Outcomes for 50 Early Cases and 51 Late Cases.: Seon, Jang Won , Huh, Jung Wook , Cho, Sang Hyuk , Joo, Jae Kyoon , Kim, Hyeong Rok , Kim, Young Jin; J Korean Soc Coloproctol. 2009;25(4):252-258.; DOI: https://doi.org/10.3393/jksc.2009.25.4.252

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PURPOSE
The present study aimed to investigate the safety and the feasibility of laparoscopic colorectal surgery performed by a surgeon during a learning period. METHODS: Between April and December 2008, 101 consecutive patients with colorectal cancers underwent laparoscopic surgery by one colorectal surgeon who previously had no experience with laparoscopic colorectal surgery. Standard laparoscopy with a lymphadenectomy using a 5-port technique was performed according to the tumor location. The patients were divided into two chronological groups: 50 cases early in learning period (early cases) and 51 cases later in the learning period (late cases). RESULTS: The operations were 29 right hemicolectomies, 9 left hemicolectomies, 18 anterior resections, 35 low anterior resections, 6 intersphincteric resections, 2 abdominoperineal resections, and 2 Hartmann's operation. There were 7 conversions (6.9%). The median operating time was 205 (range, 95-385) min, and the median blood loss was 258 (50-800) mL. The median times to flatus per anus and to feeding of soft diet were 2 (1-5) and 4 (2-13) days, respectively. The median hospital stay was 9 (6-27) days. There were 21 postoperative complications, including 7 anastomotic complications (3 leakages, 3 abscesses, and 1 stenosis). The median number of lymph nodes harvested was 20 (4-65). The operating time, blood loss, and complication rates were significantly decreased in the late group. CONCLUSION: Our initial experience with laparoscopic colorectal surgery appears to have acceptable perioperative results and short-term oncologic outcomes, which improved with the experience of the surgeon.

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Initial experience of a surgical fellow in laparoscopic colorectal cancer surgery under training protocol and supervision: comparison of short-term results for 70 early cases (under supervision) and 73 late cases (without supervision)
Ji-Hun Kim, In-Kyu Lee, Won-kyung Kang, Seung-Teak Oh, Jun-Gi Kim, Yoon-Suk Lee
Surgical Endoscopy.2013; 27(8): 2900. CrossRef

Learning Curve for Laparoscopic Colorectal Surgery: Hand Assisted Laparoscopic Surgery (HALS) versus Conventional Laparoscopic Surgery (CLS).: Yun, Hae Ran , Lee, Won Suk , Yun, Seong Hyeon , Lee, Woo Yong , Chun, Ho Kyung; J Korean Soc Coloproctol. 2007;23(3):161-166.; DOI: https://doi.org/10.3393/jksc.2007.23.3.161

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Abstract PDF

Purpose
Laparoscopic colorectal surgery is technically demanding and needs a longer learning curve than open surgery. HALS (hand-assisted laparoscopic surgery) is a useful alternative to conventional laparoscopic surgery (CLS) because of its palpability and hand dissection. We compared the learning curves between HALS and CLS for colorectal surgery. Methods: A prospective study without randomization was conducted with the participation of two colorectal surgeons who had not experienced a laparoscopic colorectal operation. The collected data included operative features, oncologic outcomes, and early clinical outcomes. Fifty patients were enrolled in each group, the HALS group and the CLS group. Results: None of the operations converted to open surgery. The operative time was significantly shorter in the HALS group than in the CLS group (149.6+/-34.6 minutes versus 179.1+/-36.5 minutes, P<0.001). On a subgroup analysis of the operative time in the anterior resection, the operative time was consistent after the 13th operation in HALS group. However, in CLS group, there was a continuous fluctuation of the operative time until 25 cases. In regard to the oncologic outcome, the numbers of total harvested lymph nodes and the proximal and the distal margins in the anterior resection showed no statistical differences (P=0.400, P=0.908, and P=0.073, respectively). The early clinical results were similar in both groups.
Conclusions
In the learning curve study, the HALS group had a shorter operative time and reached a learning curve plateau earlier than the CLS group. Other parameters, such as the oncologic results and the early postoperative clinical outcomes, showed no differences between the two groups.

Citations

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Comparison and short-term outcomes between hand-assisted laparoscopic surgery and conventional laparoscopic surgery for anterior resections of left-sided colon cancer
Hae Ran Yun, Yong Kwon Cho, Yong Beom Cho, Hee Cheol Kim, Seong Hyeon Yun, Woo Yong Lee, Ho-Kyung Chun
International Journal of Colorectal Disease.2010; 25(8): 975. CrossRef

Early Experiences with Laparoscopic- assisted Colectomy: Retrospective Comparison with Open Colectomy (Case-control Study).: Park, Ki Jae , Lee, Mi Ri , Choi, Hong Jo; J Korean Soc Coloproctol. 2007;23(3):152-160.; DOI: https://doi.org/10.3393/jksc.2007.23.3.152

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Purpose
The aim of this study was to review our experience with laparoscopic-assisted colectomy (LACs), and to evaluate its feasibility and safety for surgical treatment of colorectal diseases, including cancer. Methods: Between September 2002 and September 2005, a LAC was performed in 58 patients. Of these, 6 cases of conversion to open colectomy were excluded from the analysis. Fifty conventional open colectomy (OCs) with clinicopathologic characteristics comparable to those of the LACs were selected and matched as a control group for comparative analysis regarding short-term oncologic and perioperative outcomes. The mean follow-up period was 13.8 (2~37) months. Results: Thirteen complications, involving 11 patients, occurred. The mean operative time of the LAC was longer than that of the OC (215 min vs. 179 min; P<0.0001). However, earlier restoration of bowel function was achieved in the LAC as measured by postoperative first flatus (2.8 days vs. 3.8 days) and intake of a clear liquid diet (4.7 days vs. 5.8 days). There was no significant difference in hospital stay (LAC vs. OC, 10.2 days vs. 11.8 days). In patients with malignancy, the proximal resection margin in the LAC was significantly shorter than that in the OC (9.2 cm vs. 13.3 cm; P<0.0001). However, there were no significant differences in the mean numbers of harvested lymph nodes (LAC vs. OC, 16.6 vs. 19.3; P=0.4330) and the mean distal resection margins (LAC vs. OC, 6.9 cm vs. 6.0 cm; P=0.1359). There were 3 distant metastases and one local recurrence during follow-up in the LAC group, but no port-site recurrence. Conclusions: In this study, we could not receive an advantage of shorter hospital stay due to the relatively high complication rate for a LAC, which may reflect a learning curve. Earlier postoperative recovery of bowel function and equal pathologic extent of resection in the LAC suggest that the LAC is an acceptable alternative procedure in the treatment of colorectal diseases, including malignancy. More experience with the LAC is necessary to overcome the learning curve. Affirmative long-term oncologic outcomes of are expected for the LAC.

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Control efficacy of Lime Bordeaux Mixture against Collectotrichum gloeosporioides JAFP5 and Serratia plymuthica JABP11 in Ginseng
Min-Jeong Kim, Chang-Ki Shim, Sang-Gu Park
The Korean Journal of Pesticide Science.2021; 25(1): 63. CrossRef
Initial Experiences with a Laparoscopic Colorectal Resection: a Comparison of Short-term Outcomes for 50 Early Cases and 51 Late Cases
Jang Won Seon, Jung Wook Huh, Sang Hyuk Cho, Jae Kyoon Joo, Hyeong Rok Kim, Young Jin Kim
Journal of the Korean Society of Coloproctology.2009; 25(4): 252. CrossRef
Short-Term Outcome of Curative One-Stage Laparoscopic Resection for Obstructive Left-Sided Colon Cancers Followed by Stent Insertion: Comparative Study with Non-Obstructive Left-Sided Colon Cancers
Hyun Sil Kim, Sung Geun Kim, Chang Hyuk Ahn, Won Kyung Kang, Yun Seok Lee, In Kyu Lee, Hyung-Jin Kim, Sang Cheol Lee, Hyeon Min Cho, Jong Kyung Park, Seong Taek Oh, Jun-Gi Kim
Journal of the Korean Society of Coloproctology.2009; 25(6): 417. CrossRef
The Impacts of Obesity on a Laparoscopic Low Anterior Resection
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The Early Experience of Laparoscopic Sigmoid Colon and Rectal Cancer Resection.: Park, Jung Kyu , Park, Joon Beom , Seong, Seung Hoon , Kim, Ik Yong , Kim, Dae Sung; J Korean Soc Coloproctol. 2007;23(1):41-45.; DOI: https://doi.org/10.3393/jksc.2007.23.1.41

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Abstract PDF

PURPOSE
The aim of this study is to assess the pathologic surgical outcome and short-term outcome of a laparoscopic colorectal resection at an early time on the learning curve in comparison with open surgery.
METHODS
Retrospectively collected data were obtained on 49 patients who underrent a laparoscopic sigmoid colon and rectal cancer resection between May 2001 and January 2006. The compared factors were the clinicopathologic characteristics, the operation time, the postoperative recovery, and complications.
RESULTS
There were no significant differences in age, sex, TNM stage, and tumor size between the laparoscopic and open-surgery groups. The operation time was significantly longer in the laparoscopic group (291.4 vs. 201.9 min P < 0.001). In the view point of postoperative recovery, the laparoscopic group showed a significant advantage in the passage of flatus. There were no significant differences in harvested LNs, proximal margin, and distal margin between the two groups. The complication rate was not significantly different, but anastomotic leakage was higher in the laparoscopic group (16.7% vs. 2%, P=0.02).
CONCLUSIONS
There were no significant differences in harvested LNs, proximal margin, and distal margin between the two groups, but anastomotic leakage was higher in the laparoscopic group.

Citations

Citations to this article as recorded by

Short-Term Outcome of Curative One-Stage Laparoscopic Resection for Obstructive Left-Sided Colon Cancers Followed by Stent Insertion: Comparative Study with Non-Obstructive Left-Sided Colon Cancers
Hyun Sil Kim, Sung Geun Kim, Chang Hyuk Ahn, Won Kyung Kang, Yun Seok Lee, In Kyu Lee, Hyung-Jin Kim, Sang Cheol Lee, Hyeon Min Cho, Jong Kyung Park, Seong Taek Oh, Jun-Gi Kim
Journal of the Korean Society of Coloproctology.2009; 25(6): 417. CrossRef

Safety and Feasibility of Laparoscopic Low Anterior Resection in Early Learning Curve.: Kang, Jeong Hyun , Park, Yoon Ah , Baik, Seung Hyuk , Lee, Kang Young , Kim, Nam Kyu , Sohn, Seung Kook , Cho, Chang Hwan; J Korean Soc Coloproctol. 2005;21(6):396-400.

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Abstract PDF: PURPOSE
After the final report of Clinical Outcomes of Surgical Therapy (COST) study group, the application of laparoscopic surgery in colon cancer a spread widely. However, laparoscopic surgery in the rectum is still regarded as a complicated procedure to start due to technical difficulties and a steep learning curve. The aim of this study was to show the safety and technical feasibility of a laparoscopic low anterior resection at an early time on the learning curve in comparison with open low anterior resection.
METHODS
The learning curves of one colorectal surgeon in open and laparoscopic low anterior resections were retrospectively compared. The compared factors were clinicopathologic characteristics, operation time, and the factors associated with postoperative recovery, morbidity and mortality.
RESULTS
There were no significant differences in age or sex between two groups. The operation time was significantly longer in the laparoscopy group (P<0.001) In the view point of postoperative recovery, the laparoscopy group showed significant advantages in hospital stay (P<0.001), the passage of flatus (P<0.001), the number of analgesics used (P=0.03), and the removal of foley catheter (P=0.001). There were no conversions in the laparoscopy group, and the complication rate was lower in the laparoscopy group (10.7% vs. 17.6%). There was no postoperative mortality in either group.
CONCLUSIONS
Even though the operation time was significantly longer in the laparoscopy group, a laparoscopic low anterior resection appears to have some benefits in postoperative recovery and morbidity. In terms of surgical outcomes, a laparoscopic low anterior resection can be performed safely even in early times on the learning curve.

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