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The "learning curve" in the performance of laparoscopic cholecystectomy.

Laparoscopic cholecystectomy was successfully performed on 23 of the first 28 patients in whom this was attempted (82.1%). After the first ten cases, the success rate increased to 94.4%. There was only one major complication which prolonged hospital stay but did not require re-operation. Operative time decreased markedly from a mean of 160 minutes for the first ten cases to 61 minutes for the remainder. This increase in operative speed was not accompanied by an increase in complications, in spite of a liberalization of patient selection criteria. It is clear that a steep "learning curve" exists for this procedure and must be recognized and appreciated if laparoscopic cholecystectomy is to become a safe and efficient procedure.