Multidimensional analysis of the learning curve for laparoscopic colorectal surgery in a regional hospital: the implementation of a standardized surgical procedure counterbalances the lack of experience

Abstract

Background Although a larger proportion of colorectal surgeries have been performed laparoscopically in the last few years, a steep learning curve prevents us from considering laparoscopic colorectal surgery as the gold standard technique for treating disease entities in the colon and rectum. The purpose of this single centre study was to determine, using various parameters and following a well-structured and standardized surgical procedure, the adequate number of cases after which a single surgeon qualified in open surgery but with no previous experience in laparoscopic colorectal surgery and without supervision, can acquire proficiency in this technique. Methods From 2012 to 2019, 112 patients with pathology in the rectum and colon underwent laparoscopic colorectal resection by a team led by the same surgeon. The patients were divided into two groups (group A:50 – group B:62) and their case records and histopathology reports were examined for predefined parameters, statistically analysed and compared between groups. Results There was no significant difference between groups in the distribution of conversions (p = 0.635) and complications (p = 0.637). Patients in both groups underwent surgery for the same median number of lymph nodes (p = 0.145) and stayed the same number of days in the hospital (p = 0.109). A statistically important difference was found in operation duration both for the total (p = 0.006) and for each different type of colectomy (sigmoidectomy: p = 0.026, right colectomy: p = 0.013, extralevator abdominoperineal resection: p = 0.050, low anterior resection: p = 0.083). Conclusions Taking into consideration all the parameters, it is our belief that a surgeon acquires proficiency in laparoscopic colorectal surgery after performing at least 50 diverse cases with a well structured and standardized surgical procedure.

Multidimensional evaluation of the learning curve for laparoscopic complete mesocolic excision for right colon cancer: a risk‐adjusted cumulative summation analysis

“…In the literature, the number of cases needed to achieve proficiency in laparoscopic colorectal surgery varies enormously, ranging from 30 to 70 [10,[26][27][28][29]; all three surgeons in our study had already performed this number of procedures prior to being included in the study. We specifically focused on the adoption of a specialized technique (such as CME) applied to a more extended procedure, and for this reason we analysed the results of surgeons with previous laparoscopic experience.…”

“…Prospectively collected data from a consecutive series of patients undergoing laparoscopic right colectomy with CME for cancer at our division (minimally invasive surgical oncology at ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy) between October 2015 and January 2021 were retrospectively analysed. Only patients operated on by colorectal surgeons having at least 50 laparoscopic right colectomies with CME completed at the time of the analysis (which is suggested to be the number required to acquire proficiency [10]) were considered. CME has been adopted at our division for all RCCs since October 2015 and all the surgeons considered began to apply it simultaneously from that date.…”

Robotic Colorectal Cancer Surgery. How to Reach Expertise? A Single Surgeon-Experience

“…Currently, several parameters have been proposed to determine the adequate number of procedures to achieve adequate expertise, but no consensus has been still reached among the author, varying the number of procedures between 11 and 152 [ 6 , 7 , 9 , 12 , 26 ].…”

“…In this setting, several parameters have been investigated to define an adequate level of proficiency, but the number of cases needed to complete the learning curve is still not well defined [ 6 , 7 , 8 , 9 , 10 , 11 ], varying between 11 and 152 [ 6 , 9 , 11 , 12 ].…”

Systemic inflammatory response in robot-assisted and laparoscopic surgery for colon cancer (SIRIRALS): study protocol of a randomized controlled trial

“…Since the implementation of robot-assisted colorectal surgery in our institution in 2017, the operating surgeons' caseloads have surpassed the learning curve of 25–45 cases [ 20 – 23 ]. In addition, in our institution, laparoscopic colorectal resections have been performed since 2005, and the operating surgeons are familiar with these surgical techniques, surpassing the learning curve of approximately 50 cases [ 24 ]. Surgical procedures will be performed either laparoscopically or entirely robot-assisted.…”