Evaluation of the Learning Curve and Complications Related to Hand-Assisted Laparoscopic Appendectomy in Children with Acute Appendicitis

Mehrdad Hoseinpour, Masoud Nazem, Borzoo Khaledifar



Introduction: Previous studies have shown that according to the learning curve, one’s knowledge and skills increase with experience and repetition. However, no studies have yet proved that the learning curve can be generalized to medical procedures. Therefore, this study aimed to evaluate the learning curve and complications of hand assisted laparoscopic appendectomy (HALA) in children with acute appendicitis.


Methods: In a time-series study in 2016, ninety 13-16 year-old children were selected as candidates for appendectomy. The participants were then consecutively divided into three groups according to admission time. The first, second, and third groups were operated on by an attending pediatric surgeon, an attending pediatric surgeon and a pediatric surgical fellow, and a pediatric surgical fellow, respectively. For each surgery, duration of surgery and hospitalization was determined and recorded, and the time trend of surgery was determined and compared in all three groups using the learning curve.


Findings: The mean duration of surgery of the groups operated on by an attending, an attending and a resident, and a resident alone was 38.7±12.8, 46.9±8.8, and 48.5±11.3, respectively, and there was a significant difference among the three groups (p=0.002). During the surgery, duration of surgery in resident and attending group and resident group decreased over time.


Discussion: The learning curve can be generalized to medical lessons and experiences. Duration of appendectomy for residents can decrease over time as they become more skilled. Usually after performing 30 surgeries and gaining experience, residents will be able to perform appendectomy nearly as fast as surgeons. In the meantime, the root causes of the fluctuations observed during surgery should be scientifically examined and taken care of.


Learning Curve, Hand Assisted, Laparoscopic Appendectomy

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DOI: https://doi.org/10.22037/irjps.v3i1.16427


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