9%) conversions respectively. Figure 4 shows the CUSUM analysis of learning curve of selleck chem Enzastaurin Surgeon A; vertical line at the 19th case indicates the predicted minimal number of cases required to overcome the SILC learning curve. Surgeon B is excluded from CUSUM analysis in this study due to limited number of cases performed. Figure 4 CUSUM analysis of learning curve of Surgeon A. Most conversions of Surgeon A happened before the first 19 cases, and subsequently his learning curve reached a plateau except two conversions in the 32nd and 67th case. Surgeon B had two conversions in his 1st and 4th case. Most conversions were due to dense adhesion at the Calot’s triangle and vital anatomical structures cannot be visualized clearly. One (5%) patient with previous abdominal surgery required conversion and one (5%) patient with active acute cholecystitis required conversion.

Table 1 shows the operative and patient profile of the first 19 cases of Surgeons A and B. Table 2 shows the profile of cases that required conversion in the first 19 cases. When comparing cases which required conversion and cases which did not require conversion, there is no significant difference between patients (1) with previous, without previous, or on-going acute cholecystitis, (2) previous abdominal surgery, and (3) mean BMI. Table 3 demonstrates the comparison of potential risk factors between cases with and without conversion. Table 1 Operative and patient profile of the first 19 cases of Surgeons A and B. Table 2 Profile of cases that required conversion in the first 19 cases.

Table 3 Comparison of potential risk factors in cases with and without conversion. 3.2. Operating Time Surgeon A’s mean operating time is significantly lower (62.5 minutes versus 90.6 minutes, P = 0.04) after he has overcome the learning curve. Conversion rates were lower as well (2.5% versus 21%, P = 0.36). Mean operating times, conversion rate, and patients’ profile of Surgeons A before and after the first 19 cases is shown in Table 4. Table 4 Mean operating times, conversion rate, and patients’ profile of Surgeons A after the first 19 cases. Figure 5 demonstrates the operating times of Surgeons A and B as their experience increased. Figure 6 demonstrates the trend line of operating time of Surgeon A (dashed line) and B (dotted line).

We found that the trend line of operating time of Cilengitide Surgeon B is steeper than Surgeon A, hence suggests that guidance from another surgeon who is experienced in SILC can facilitate the learning curve rapidly. Surgeon A SILC operating time trend line crosses his CLC operating time trend line (straight line) at the 82th case, which is suggestive of that SILC operating time may be faster than CLC eventually as the experience increases further. Figure 5 Operating times of Surgeons A and B. Figure 6 Trend lines of operating time of Surgeons A and B. Trend line of Surgeon B showed faster improvement in operating time with mentoring from Surgeon A.