Learning curves for transperitoneal laparoscopic and extraperitoneal endoscopic paraaortic lymphadenectomy

Study Objective. To compare learning curves for paraaortic lymphadenectomy by extraperitoneal endoscopic approach with those for transperitoneal laparoscopy. Design. Randomized, long-term study (Canadian Task Force classification I). Setting. Animal laboratory. Subjects. Sixty-six pigs. intervention. Laparoscopic and endoscopic paraaortic lymphadenectomy, 33 pigs in each group, performed by two surgeons competent in laparoscopic surgery but without experience in endoscopic paraaortic lymphadenectomy. Measurements and Main Results. The duration of the procedure, number of lymph nodes removed, and number of residual nodes revealed learning curves that stabilized after the tenth procedure for each surgeon and for each approach. Vascular trauma depended on experience, occurring during the first 10 procedures for each surgeon. Efficacy and operative morbidity were comparable for the two procedures. Conclusion. Endoscopic extraperitoneal lymphadenectomy has a steep learning curve similar to that for transperitoneal laparoscopy.