The surgical procedures are technically difficult, but with previous laparoscopic experience from appendectomies, cholecystectomies, and hernia repair the learning curve is not differing from that of conventional open colorectal surgery [25]. better A theory could be that older surgeons initially may have difficulties in seeing 3-dimensional structures on a 2-dimensional screen, while younger upcoming surgeons have grown up with this from for example, computer games [29]. Most studies defined learning curves from intraoperative complications, rate of conversion to open surgery, and eventually number of harvested lymph nodes and operating time. Adequate learning occurred after 5�C80 interventions [24�C28, 30].

The reasons for the wide spread in these results could be that the studies were based on a few surgeons and these results are of course very much dependent on the skills of the specific surgeon. In one study with three surgeons the time for adequate learning ranged from 5�C17 interventions [24]. Based on these studies and our own experiences we believe that laparoscopic colonic and rectal resections can be learned as quickly, effectively, and safely as conventional open resections. 5. Conclusion Implementing laparoscopic colonic and rectal resection for colorectal malignancies in our department resulted, for patients with primary anastomoses, in shorter hospital stay compared with conventional open surgical technique. The implementation of laparoscopic colorectal surgery was done without implementing fast track principles for perioperative care.

This study confirms that laparoscopic CRC surgery can be implemented successfully. The short-term outcomes after laparoscopic CRC surgery are superior to conventional open surgery. The long-term effects have to be confirmed in large randomised controlled trials, but do not seem worse than after open repair. A part of our success with laparoscopic repair concerning length of hospital stay could theoretically be patient, surgeon, or nursing staff biased. Therefore, future studies should evaluate the effect of laparoscopic versus open surgery in a blinded trial and without implementing fast track principles for perioperative care. Conflict of Interests The authors declare that they have no conflict of interests, this in accordance with the ICMJE criteria. Authors’ Contribution J. Rosenberg and S. K.

Burgdorf carried out the data collection. J. Rosenberg and S. K. Burgdorf designed the study. S. K. Burgdorf performed the statistical analyses. S. K. Burgdorf Carfilzomib drafted the manuscript. Both authors read and approved the final paper.
Traditional cardiac surgery requires a sternotomy, cardiopulmonary bypass, and cardiac arrest to provide a still and bloodless heart and its vessels for operation. While necessary, these interventions are invasive and traumatic. The morbidity of cardiac surgery can be quite a burden to the patients [1�C3].