Introduction: The introduction of laparoscopic techniques to paediatric surgery has focussed attention on the surgical learning curve. There is concern that children may be liable to adverse events during a surgeon’s initial practice with what are novel techniques. The aims of this study were to assess whether there were significant disadvantages to children in the course of a paediatric surgeon’s learning curve.
Methods: All operations following the introduction of laparoscopic surgery in one regional unit were prospectively recorded. Procedures were compared with the chronologically preceding open procedure. Case note review allowed determination of duration of surgery, time to discharge, analgesia requirement and complication rates. Statistical analysis used Mann-Whitney for comparison of medians and χ2 for comparison of proportions.
Results: 31 laparoscopic procedures were performed in the 4 months following the introduction of laparoscopic techniques: fundoplication 24; ACE 2; appendicectomy 2; ovarian cystectomy 1; Palomo procedure 1; Morgagni hernia 1. The average time to discharge was significantly shorter for the laparoscopic cases (Median time to discharge laparoscopic group 4d, median time open group 7d 95% ci of difference 1.9 – 4, p<0.001). The laparoscopic group had significantly less total opiate requirement (Median opiate administered expressed as mg/kg. Laparoscopic group 0.29, median opiate open group 1.09 95%ci of difference 0.4-0.9, p=0.001). Complications of any type were less frequent in the laparoscopic group (6/31 vs. 9/31 p = ns). The average operative time was longer in the laparoscopic group, but the difference was not significant (Mean operative time laparoscopy 150min, mean operative time open group127min, p=ns)
Discussion: While there is undoubtedly a learning curve to paediatric laparoscopic surgery, our experience is that this does not lessen the advantages of laparoscopy to children, who benefit from earlier discharge and less analgesic requirements. We are unable to find objective evidence of a “learning curve”, looking either at duration of surgery, or complications in our initial 31 cases.
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