Background & objectives: Laparoscopic splenectomy had become the golden standard for elective splenectomy, as it is feasible, safe and provides many advantages to the patients in comparison to open splenectomy. However, a learning curve exists for mastering the procedure and defining will be helpful in designing a training program for laparoscopic splenectomy.
Methods: 57 patients underwent elective laparoscopic splenectomy for different indications in our hospital between August 2011 and September 2013. Patients' data whether preoperative, operative or postoperative were collected, subdivided in 10 cases groups and certain outcome measures were statistically analyzed to identify the learning curve.
Results: Laparoscopic splenectomy was done for all patients. The mean operative times in the 3rd, 4th, 5th and 6th groups were significantly shorter than the 1st and 2nd groups. There was a trend toward decreased blood loss in the latter groups (3rd, 4th, 5th and 61h), and the differences between them and the first two groups were statistically significant. There was a trend of high postoperative complications and conversion rate in the first group in relation to the other groups, but a statistically significant difference between groups couldn't be found. Similarly, there was a trend towards decreased period of ileus with the consecutive groups; but a statistically significant difference couldn t be shown. A statistically significant difference in hospital stay was found between the consecutive groups. The results showed that the outcome measures were seen to improve with the advancement of the experience with a plateau reached after 20-30 cases oflaparoscopic splenectomy.
Conclusion: Laparoscopic splenectomy can be done safely by experienced laparoscopic surgeons. A learning curve for mastering the procedure is 20-30 cases, after which the outcome parameters nearly reaches a plateau.