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  • Title: Evaluation of the learning curve for a board-certified veterinary surgeon performing laparoendoscopic single-site ovariectomy in dogs.
    Author: Runge JJ, Boston RC, Ross SB, Brown DC.
    Journal: J Am Vet Med Assoc; 2014 Oct 01; 245(7):828-35. PubMed ID: 25229536.
    Abstract:
    OBJECTIVE: To define the learning curve and evaluate the outcome for a board-certified veterinary surgeon performing laparoendoscopic single-site (LESS) ovariectomy in dogs. DESIGN: Retrospective case review and learning curve evaluation with a skill acquisition model. Animals-27 client-owned dogs. Procedures-Between April 2011 and December 2012, 27 dogs underwent elective LESS ovariectomy performed by a single experienced board-certified laparoscopic surgeon by means of the same technique. Medical records for these patients were reviewed to determine whether a learning curve could be detected. A commercially available multitrocar port was inserted through a 15- to 20-mm incision at the umbilicus, and LESS ovariectomy was performed with articulating graspers, a bipolar vessel-sealing device, and a 30° telescope. Surgical performance of the surgeon was quantified with an exponential skill acquisition model, and how skill was gained with repetition of the same novel surgical procedure was examined. RESULTS: Median patient body weight was 20 kg (44 lb; range, 3.5 to 41 kg [7.7 to 90.2 lb]). Median surgical time was 35 minutes (range, 20 to 80 minutes). Median patient age was 314 days (range, 176 to 2,913 days). The skill acquisition model revealed that a comparable surgeon could reach 90% of optimal surgery performance after approximately 8 procedures (8.6, 95% confidence interval, 0.5 to 16.6 procedures). According to the model, with each surgery, surgical time would be expected to decrease by 27% (95% confidence interval, 2% to 52%). Complications were limited to minor hemorrhage due to a splenic laceration and a postoperative incisional infection. Follow-up information was available for all 27 cases. All owners were satisfied and indicated that they would pursue LESS ovariectomy again. CONCLUSIONS AND CLINICAL RELEVANCE: The learning curve for LESS ovariectomy was short and definable. Short-term outcome was excellent. Results of this study suggested that an experienced laparoscopic surgeon may anticipate achieving proficiency with this technique after performing approximately 8 procedures.
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