Published online Jun 16, 2022. doi: 10.4253/wjge.v14.i6.387
Peer-review started: January 24, 2022
First decision: April 17, 2022
Revised: April 23, 2022
Accepted: May 17, 2022
Article in press: May 17, 2022
Published online: June 16, 2022
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.
To display our experience in the learning curve status of laparoscopic colorectal surgery under a non-structured training setting.
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.
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.
The learning curves in our setting validate the comparability of the results, despite the absence of National or Surgical Society driven training programs.
Core Tip: In terms of operative time, the learning curve of a dedicated colorectal surgical team consists of three phases. Change point analysis identified the 110th case as the separation key-point of the first two phases. A plateau was reached after the 145th case. Although we were able to confirm the presence of a learning curve pattern in the histopathological endpoints, this was not the case for the open conversion and morbidity outcomes. Formal training program initiatives are necessary for the safe and efficient implementation of laparoscopic colorectal operations.