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

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 110 th case as the first turning point. A plateau was reached after the 145 th case. Subgroup analysis estimated the 58 th for colon and 52 nd 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.

Minimally Invasive Colorectal Surgery Techniques

“…The majority of the current research supporting the advantages of robot-assisted laparoscopic rectal cancer surgery comes from case studies. Robotic surgery is both feasible and similar to laparoscopic TME, according to case-matched and nonrandomized studies [20].…”

Short-Term Outcomes of First 100 Laparoscopic Colorectal Surgeries at a Newly Developed Surgical Setup at Peshawar

“…Laparoscopic surgery, a hallmark of MIS, has emerged as a convincing alternative to traditional open resections for CRC [5]. While studies affirm the non-inferiority of laparoscopy in long-term outcomes, its adoption faces challenges due to the demanding learning curve [6][7][8]. The effectiveness of laparoscopic techniques lies not only in their safety, validated through randomized control trials, but also in their potential to improve short-term outcomes, revolutionizing surgical practices [9][10][11].…”