The tail of the learning curve for laparoscopic cholecystectomy

Background: This study estimates the number of laparoscopic cholecystectomies required until improvement ceases, assesses the magnitude of such improvement, and provides some insight into the mechanism by which it takes place. Methods: Data from 500 consecutive laparoscopic cholecystectomies were analyzed from a prospective data base for number of short and long operations and operative time. Results: There was a 40% decrease (P <0.05) in average operative time over the first 200 operations. Significant decrease in the number of longer operations, increase of shorter cases, and decrease in the range of operative time were noted. The major contributor was a marked shortening of longer cases, without much increased speed of shorter operations. Conclusion: For laparoscopic cholecystectomy, improvement persists for about 200 operations, resulting in a 40% reduction in operative time. The primary mechanism of improvement seems to be an ability to deal more effectively with difficult cases