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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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