Surgical educationIs the learning curve for laparoscopic fundoplication determined by the teacher or the pupil?
Section snippets
Material and methods
The study group was confined to 12 pairs of “master” and “pupil” surgeons from different Nordic centers. Each master was a fully trained surgeon with considerable experience in laparoscopic fundoplication. The pupil was a surgeon under training with experience in laparoscopic surgery in general but not in laparoscopic fundoplication specifically. The intent was to teach the pupil to perform this procedure. Each master defined his or her “gold standard” by fully describing the operative
Results
Two hundred twenty-one patients were included in the study. Not all centers included 20 patients for various reasons; 5 pupil procedures were still assessed for these centers with a narrowed interval. The conversion rate was 3 % (6 of 221), and postoperative hospital stay was 3 days in the median (interquartile range 1 day). There was no significant decrease in hospital stay during the series. Eight complications were reported: 6 patients with dysphagia were treated with endoscopy and
Discussion
When the learning curve in laparoscopic fundoplication is described, measurements such as conversion rate, complications, and operating time are traditionally used [1], [3], [7]. For obvious reasons, patient outcome is the most important long-term quality measurement, but this can be considered somewhat blunt. Watson et al [1] demonstrated different aspects of the learning curve for laparoscopic fundoplication in 280 cases performed by 11 surgeons in a single institution study. In their
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