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. 2022 Jun 16;14(6):387-401.
doi: 10.4253/wjge.v14.i6.387.

Change point analysis validation of the learning curve in laparoscopic colorectal surgery: Experience from a non-structured training setting

Konstantinos Perivoliotis  1 , Ioannis Baloyiannis  2 , Ioannis Mamaloudis  1 , Georgios Volakakis  1 , Alex Valaroutsos  1 , George Tzovaras  1
Affiliations

Change point analysis validation of the learning curve in laparoscopic colorectal surgery: Experience from a non-structured training setting

Konstantinos Perivoliotis et al. World J Gastrointest Endosc. .

Abstract

Background: The introduction of minimal invasive principles in colorectal surgery was a major breakthrough, resulting in multiple clinical benefits, at the cost, though, of a notably steep learning process. The development of structured nation-wide training programs led to the easier completion of the learning curve; however, these programs are not yet universally available, thus prohibiting the wider adoption of laparoscopic colorectal surgery.

Aim: To display our experience in the learning curve status of laparoscopic colorectal surgery under a non-structured training setting.

Methods: We analyzed all laparoscopic colorectal procedures performed in the 2012-2019 period under a non-structured training setting. Cumulative sum analysis and change-point analysis (CPA) were introduced.

Results: Overall, 214 patients were included. In terms of operative time, CPA identified the 110th case as the first turning point. A plateau was reached after the 145th case. Subgroup analysis estimated the 58th for colon and 52nd case for rectum operations as the respective turning points. A learning curve pattern was confirmed for pathology outcomes, but not in the conversion to open surgery and morbidity endpoints.

Conclusion: The learning curves in our setting validate the comparability of the results, despite the absence of National or Surgical Society driven training programs.

Keywords: Colorectal; Education; Gastrointestinal; Laparoscopy; Outcomes.

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Conflict of interest statement

Conflict-of-interest statement: We have no financial relationships to disclose.

Figures

Figure 1
Figure 1
Cumulative sum analysis of operation duration in laparoscopic colorectal operations. CUSUM: Cumulative sum; LCRO: Laparoscopic colorectal operations.
Figure 2
Figure 2
Cumulative sum analysis of operation duration in laparoscopic colon operations. CUSUM: Cumulative sum; LCO: Laparoscopic colon operations.
Figure 3
Figure 3
Cumulative sum analysis of operation duration in laparoscopic rectal operations. CUSUM: Cumulative sum; LRO: Laparoscopic rectal operations.
See this image and copyright information in PMC

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References

    1. Yamanashi T, Nakamura T, Sato T, Naito M, Miura H, Tsutsui A, Shimazu M, Watanabe M. Laparoscopic surgery for locally advanced T4 colon cancer: the long-term outcomes and prognostic factors. Surg Today. 2018;48:534–544. - PMC - PubMed
    1. Yamaguchi S, Tashiro J, Araki R, Okuda J, Hanai T, Otsuka K, Saito S, Watanabe M, Sugihara K. Laparoscopic versus open resection for transverse and descending colon cancer: Short-term and long-term outcomes of a multicenter retrospective study of 1830 patients. Asian J Endosc Surg. 2017;10:268–275. - PubMed
    1. Son GM, Kim JG, Lee JC, Suh YJ, Cho HM, Lee YS, Lee IK, Chun CS. Multidimensional analysis of the learning curve for laparoscopic rectal cancer surgery. J Laparoendosc Adv Surg Tech . 2010;20:609–617. - PubMed
    1. Mackenzie H, Miskovic D, Ni M, Parvaiz A, Acheson AG, Jenkins JT, Griffith J, Coleman MG, Hanna GB. Clinical and educational proficiency gain of supervised laparoscopic colorectal surgical trainees. Surg Endosc. 2013;27:2704–2711. - PubMed
    1. Rao PP, Rao PP, Bhagwat S. Single-incision laparoscopic surgery - current status and controversies. J Minim Access Surg. 2011;7:6–16. - PMC - PubMed