The Learning Curve of Totally Laparoscopic Aortobifemoral Bypass for Occlusive Disease. How Many Cases and How Safe?

Objectives Totally laparoscopic aortic surgery is appealing. However, the adoption of this technique in the broad vascular world is hampered by the steep learning curve and the fear of exposing patients to excessive morbidity and mortality. We assessed how many patients should be treated to overcome...

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Bibliographic Details
Published in:European journal of vascular and endovascular surgery 2008-06, Vol.35 (6), p.723-729
Main Authors: Fourneau, I, Lerut, P, Sabbe, T, Houthoofd, S, Daenens, K, Nevelsteen, A
Format: Article
Language:English
Subjects:
Adult
Aged
Anastomosis, Surgical - education
Aorta - surgery
Aortic laparoscopy
Aorto-iliac occlusive disease
Arterial Occlusive Diseases - mortality
Arterial Occlusive Diseases - surgery
Blood Loss, Surgical
Clinical Competence
Female
Femoral Artery - surgery
Humans
Laparoscopy - adverse effects
Learning curve
Length of Stay
Male
Middle Aged
Morbidity
Mortality
Prospective Studies
Severity of Illness Index
Surgery
Time Factors
Treatment Outcome
Vascular Surgical Procedures - adverse effects
Vascular Surgical Procedures - education
Workload
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Summary:Objectives Totally laparoscopic aortic surgery is appealing. However, the adoption of this technique in the broad vascular world is hampered by the steep learning curve and the fear of exposing patients to excessive morbidity and mortality. We assessed how many patients should be treated to overcome this learning curve. Materials and methods The first 50 patients treated with totally laparoscopic aortobifemoral bypass for severe aorto-iliac occlusive disease were followed prospectively. Operative variables such as operative time, aortic clamping time, amount of blood loss, conversion to laparotomy etc were recorded (as well as 30-day mortality and morbidity). To discover a turning point we used the technique of sliding averages. These data were compared with the mortality and morbidity as predicted by POSSUM and P-POSSUM. Results A clear turning point, with improved operative variables, was seen after 20–30 patients. Mortality and morbidity were not higher than predicted by POSSUM and P-POSSUM. Conclusions These data confirm the intuition of most people involved in laparoscopic aortic surgery that the learning curve could be set at 25–30 cases. However, patients are not exposed to excessive morbidity and mortality during this learning curve.
ISSN:1078-5884
1532-2165
DOI:10.1016/j.ejvs.2008.01.005