Learning curve for transanal endoscopic microsurgery: a single-center experience

Abstract

The ARE significantly declined after the first four cases. The LC for TEM is associated with a significant decrease in operative time after four cases.

Transanal endoscopic surgery: patient selection and perspectives

“…In addition, the operative time as well as the average rate of rectal lesion excision using TEM significantly decreased after four cases (mean operating time of 130.5 minutes for specimens with a mean size of 16.6 cm 2 with minimal fragmentation and morbidity). 3 This is encouraging for surgeons who are interested in learning this technique given that the learning curve may not be as steep as initially anticipated on the basis of the results of this study. However, it is important to realize that with any new technique, steady practice is important to maintain skills and improve performance over time.…”

“…3 Since then, a multitude of studies have been published showing the benefits of TES, encouraging surgeons to adopt this new wave in colorectal surgery. Courses and workshops around the globe have allowed surgeons with different levels of experience and expertise to train on the different TES platforms, teaching the basics of setup and surgical technique.…”

“…2 As with all new procedures, the surgical community was slow to adopt this approach due to its cost, its perceived difficulty as well as its limited use in colorectal surgery. 3 Nonetheless, after many years of practice and robust clinical studies, TES has gained the interest of surgeons who prefer to treat their patients using more minimally invasive approaches.…”

“…12 Although a learning curve effect was calculated in this study, there was no mention of an actual number of cases required before a surgeon demonstrates a certain level of proficiency with this procedure. A recent retrospective study by Maya et al 3 assessed the learning curve of a single surgeon performing TEM using the Wolf platform in 23 cases. Using a Cumulative sum technique, which is an objective assessment tool of individual surgeon performance, they were able to demonstrate stabilization of the learning curve for TEM after four cases.…”

The role of transanal total mesorectal excision in rectal surgery

“…TEM was not widely adopted due to its high costs, technical complexity and the long learning curve. However, Maya et al [5] showed by Cussum analysis that the learning curve for TEM is associated with a significant decrease in operative time after only four cases.…”