Learning curve and global benchmark values of laparoscopic sleeve gastrectomy: results of first 100 cases of a newly trained surgeon in an Italian center of excellence

Abstract

To evaluate whether the learning curve for sleeve gastrectomy could be completed after 50 cases. First 100 patients undergoing LSG under a newly trained laparoscopic surgeon were included in this study and divided into two groups of 50 consecutive patients each. Perioperative outcomes were compared to recently introduced global benchmarks. Short-term weight loss was calculated as Total Weight Loss Percent (%TWL) and complications were classified in accordance with the Clavien–Dindo classification. CUSUM analysis was performed for operative time and hospital stay. Mean preoperative age and BMI were 41.8 ± 10.3 years and 42.9 ± 5.4 kg/m2, respectively. Demographics and rate of patients with previous surgery were comparable preoperatively in the two groups. Mean operative time was 92.1 ± 19.3 min and hospital stay was 3.4 ± 0.6 days as per our standard protocol of discharge. Uneventful postoperative course was recorded in 93% of patients and only one case of staple line leak was registered in the first 50 cases (group 1). No statistical difference in BMI and %TWL was found between the two groups at any time of follow-up. Comparison between two groups showed a significant reduction in hospital stay and operative time after the first 50 LSGs (p < 0.05). LSG can be performed by newly trained surgeons proctored by senior tutors. At least 50 cases are needed to meet global benchmark cut-offs and few more cases may be required to reach the plateau of the learning curve.

A Hub and Spoke Learning Program in Bariatric Surgery in a Small Region of Italy

“…During the follow-up, our patients had a consistent reduction in BMI and our findings were in line with results from referral centers for BS ( 35 , 51 , 63 ).…”

“…Analyzing our results concerning preoperative patient characteristics, they are superimposable to other relevant casistics from referral centers for BS ( 35 ). All the patients have at least one comorbidity in addition to obesity.…”

“…The mean hospital stay is higher than the length of stay (LOS) reported in the literature for a high-volume center for LSG ( 35 , 49 – 51 ). As known, LOS may be influenced by modifiable and non-modifiable factors ( 52 ).…”

“…Moreover, a proper step by step learning curve of the whole team was established to achieve the best results as described in Vitiello et al's experience ( 35 ).…”

Lessons from the COVID-19 pandemic: remote coaching in bariatric surgery

“…Despite that LSG is technically less complex than other bariatric procedures, it takes at least 50–100 cases for a newly trained surgeon to become proficient[ 15 , 16 ]. In our series, operative time progressively decreased with a significant reduction already after the fourth case.…”