Sigmoid resection for diverticulitis is more difficult than for malignancies

Stam, M. A. W.; Draaisma, W. A.; Pasker, Pcm; Consten, E.C.J.; Broeders, I. A. M. J.

doi:10.1007/s00384-017-2756-1

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…Kubat et al [ 20 ] described the same progression in robotic single-site cholecystectomies, who suggested that the learning curve could be accelerated by first acquiring the skills necessary to complete elective cases. This concept is not new when considering the studies by Stam et al [ 45 ] and Naguib et al [ 46 ] who highlighted that laparoscopic colorectal resections for diverticular disease are technically challenging and more difficult than the resections performed for oncological indications in an elective setting. The study by Miskovic et al, based on an international multicenter analysis of 4852 cases, confirmed that the learning curve in colorectal surgery should include difficult cases like emergency surgery only in the later stages [ 47 ].…”

Section: Resultsmentioning

confidence: 99%

Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

et al. 2023

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Background Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS. Methods This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements. Results Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20–107) depending on the initial surgeon’s experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon’s proficiency. Conclusions Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.

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Section: Resultsmentioning

confidence: 99%

Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

et al. 2023

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“…The learning curve in laparoscopic right hemicolectomy in the emergency setting is steeper compared to the elective one, primarily due to the local inflammation that subverts the normal anatomy 22 : Surgery should be performed by expert hands to improve surgical outcomes, reducing operative time, the LOS, and ensuring the best possible assistance to the patient.…”

Section: Discussionmentioning

confidence: 99%

Right‐sided colonic diverticulitis. Short and long‐term surgical outcomes and 2‐year quality of life

Lauricella,

Brucchi,

Palmisano

et al. 2024

World j. surg.

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AimWe aimed to investigate the short and the long‐term outcomes and 2‐year Quality of Life (QoL) of patients with right‐sided colonic diverticulitis (RCD) surgically managed.MethodWe conducted an ambidirectional cohort study of patients with RCD undergoing surgery between 2012/2022. A colonoscopy was performed at 1‐year post surgery. The enrolled patients completed the EuroQoL (EQ‐5D‐3L) during a regular follow‐up visit at 12 and 24 months after surgery.ResultsThree hundred nineteen patients with RCD were selected: 223 (70%) patients were treated by non‐operative management (NOM) while 33 underwent surgery. Acute diverticulitis occurred in 30 patients: 9 (27.2%) were classified by CT as uncomplicated and 21 (63.6%) as complicated diverticulitis. Additionally, chronic diverticulitis occurred in 3 cases (9.2%). Specifically, 27 patients were classified by CT as 1a (81.8%) and 6 patients as 3 (18.2%). Right hemicolectomy was performed in 30 patients (90.8%), and ileo‐caecectomy in 3 (9.2%). Nine (27.27%) experienced postoperative complications: 7 (77.7%) were classified according to the Clavien‐Dindo as grade I‐II, and 2 (22.2%) as grade III. No disease recurrence or colorectal cancer (CRC) was detected on colonoscopy. Thirty (90.8%) patients completed the 24‐month follow‐up. A statistically significant difference between preoperative and 24‐month QoL index values (median 0.72; IQR = 0.57–0.8 vs. median 0.9; IQR = 0.82–1; p = 0.0003) was observed.ConclusionsThe study results demonstrate satisfactory surgical outcomes and a better QoL after surgery. No disease recurrence or CRC was observed at colonoscopy 1 year after surgery.

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“…Among the various statistical methodologies that have been employed for the LC evaluation are the group splitting, moving average, and CUSUM analysis[ 3 , 17 , 32 , 33 ]. Following an introductory learning phase, the trainee is gradually performing operations of higher complexity and difficulty[ 34 , 35 ]. Finally, once the iteration of the process does not affect the measured variable, mastery is achieved[ 16 , 17 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

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

Perivoliotis¹,

Baloyiannis²,

Mamaloudis³

et al. 2022

WJGE

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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.

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Sigmoid resection for diverticulitis is more difficult than for malignancies

Abstract: The outcomes of our study show that diverticulitis may not be the ideal condition to start the learning process for laparoscopic colorectal surgery.

Cited by 5 publications

References 19 publications

Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

Right‐sided colonic diverticulitis. Short and long‐term surgical outcomes and 2‐year quality of life

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

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