The learning curve for laparoscopic colectomy in colorectal cancer at a new regional hospital

Tsai, Kuei-Yen; Kiu, Kee Thai; Huang, Ming Te; Wu, Chih Hsiung; Chang, Tsu‐Chung

doi:10.1016/j.asjsur.2015.03.008

Cited by 21 publications

(15 citation statements)

References 24 publications

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“…In a previous report, the surgeons' procedure time stabilized after the performance of 15 sigmoidectomy procedures as the primary operator [11]. Although the experience of the scope operator should be considered an important contributor to a meticulous laparoscopic surgery, the learning curve of the scope operator may plateau after a relatively small number of times assisting with sigmoidectomy or anterior resection (approximately 4 procedures).…”

Section: Discussionmentioning

confidence: 97%

Reduction in the Frequency of Scope Contamination During Laparoscopic Surgery Correlates with Scope Operator Experience

Ito

Minamimura

Tanaka

et al. 2020

Preprint

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Background As laparoscopic colorectal cancer surgery becomes more common in mid-sized municipal hospitals in Japan, young trainees have increasing opportunities to attend laparoscopic colorectomy procedures as a scope operator. However, the performance of the inexperienced scope operator may affect the operative outcome. This study aims to provide a quantitative measure of the scope operator’s performance, by analyzing scope contamination events, and to determine the influence of this measure on surgical outcomes.Methods We retrospectively analyzed the operative videos of 70 sigmoid colectomy or high anterior resection cases performed between February 2014 and July 2019 in our hospital. Twenty-four young surgeons alternated assisting with the procedure as the scope operator. To quantify the scope operators’ performance, the frequency of laparoscopic lens contamination events (FLC) during surgery was determined. The FLC and operative outcomes were compared among the first, second, and subsequent procedures performed by each scope operator. We identified the cause of lens contamination and surgical situation in which contamination occurred. We examined the relationship between the FLC and experience level of the scope operator for specific types of contamination and surgical situations.Results A total of 733 lens contaminations were observed. The median FLC was 10 (minimum: 1, maximum: 34) during each operation. The FLC and number of procedures performed by the scope operator had a negative linear correlation. Multivariate analysis showed that the experience level of the scope operator was the only independent predictor of operation time. There was also a negative linear correlation between the number of procedures performed by the scope operator and scope contamination during colorectal mobilization.Conclusions Scope operator experience decreases scope contamination and could facilitate the laparoscopic surgical workflow. The influence of the scope operator’s performance should be emphasized.

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Section: Discussionmentioning

confidence: 97%

Reduction in the Frequency of Scope Contamination During Laparoscopic Surgery Correlates with Scope Operator Experience

Ito

Minamimura

Tanaka

et al. 2020

Preprint

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“…In the present trial, participation in at least 30 laparoscopic surgeries was required. Although it might be debatable as to whether 30 surgeries is an appropriate number, research into the learning curve in the first half of the 2000s, and also in recent reports, found that laparoscopic procedures stabilized when surgeons had experienced approximately 30 procedures . Certification by the endoscopic surgical skill qualification system introduced by JSES has been required since 2 years after the first patient was registered in this trial (2006) .…”

Section: Discussionmentioning

confidence: 99%

Transitional impact of short‐ and long‐term outcomes of a randomized controlled trial to evaluate laparoscopic versus open surgery for colorectal cancer from Japan Clinical Oncology Group Study JCOG0404

Fujii

Akagi

Ito

et al. 2019

Annals of Gastroent Surgery

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Background The JCOG0404 randomized controlled trial conducted to compare laparoscopic surgery (LAP) with open surgery (OP) for stage II/III colon cancer showed better short‐term outcomes and equal long‐term outcomes of LAP versus OP. Technical instrumentation of surgery and anticancer agents given during the registration period might have affected the outcomes. Aim To evaluate outcomes according to the registration periods. Methods The overall registration period was divided into three periods (first: 2004‐2005, second: 2006‐2007 and third: 2008‐2009). Short‐term and long‐term outcomes were compared between registration periods. Results In total, 1057 patients were registered. Numbers of patients undergoing each approach for each of the three periods (1st/2nd/3rd) were 528 for OP (106/244/178) and 529 for LAP (106/246/177). Operation time (minutes) did not change between the periods for OP (160/156/161) or LAP (205/211/219). Blood loss (mL) gradually decreased in the latter two periods: (119/80/75) for OP and (35/28/25) for LAP. Incidence of complications (%) decreased in the latter periods for OP (27.6/20.3/21.3), whereas that for LAP remained consistently low (14.3/14.8/13.6). There was no particular trend in 5‐year overall survival and recurrence‐free survival depending on the period regardless of treatment. D3 dissection rates were 95% or more for all periods in both groups. Conclusions Operation time and survival rates did not change over time, whereas blood loss in OP improved in the latter periods. Quality control applied in this trial might have been effective in producing such safe endpoints. (ClinicalTrials.gov, number NCT00147134, UMIN Clinical Trials Registry, number C000000105.)

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“…La courbe d’apprentissage ne doit pas constituer un frein à l’utilisation de la laparoscopie en particulier dans les cancers coliques non métastatiques. Une équipe asiatique a étudié l’impact de la courbe d’apprentissage dans un hôpital régional et a montré que cette voie d’abord était parfaitement sure et reproductible [23]. Dans notre série, la courbe d’apprentissage a eu un impact sur le temps opératoire sans pour autant influencer la morbi-mortalité, la récidive ou la survie.…”

Section: Discussionunclassified

Colectomie laparoscopique versus colectomie par laparotomie dans le traitement des adénocarcinomes coliques non métastatiques

Bayar¹,

Mzoughi²,

Djebbi³

et al. 2016

Pan Afr Med J

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IntroductionLa colectomie laparoscopique pour cancer colorectal constitue, de plus en plus, le traitement de référence. L’objectif de notre travail est de montrer que les résultats à court terme etla sécurité oncologique que procure la voie laparoscopique sont au moins équivalents à ceux de la laparotomie dans le traitement des adénocarcinomes coliques non métastatiques. Nous nous proposons également d’étudier l’impact de la courbe d’apprentissage sur les résultats de la laparoscopie dans ces cancers.MéthodesIl s’agit d’une étude rétrospective incluant tousles patients opérés pour des adénocarcinomes coliques résécablessur une période de 6 ans. La population de l’étude était répartie en 2 groupes, selon la voie d’abord utilisée initialement. Le groupe « OC » comprenait 35 patients opérés par laparotomie médiane et le groupe « LAC » comprenait 30 patients opérés par laparoscopie. Toutes les données étaient analysées au moyen du logiciel SPSS version 19.0.RésultatsNotre étude n’a pas montré de différence significative dans les résultats à court terme entre les 2 groupes à savoir la morbidité per-opératoire, le séjour hospitalier, le séjour en milieu de réanimation ainsi que la morbi-mortalité postopératoire. Concernant les résultats à long terme, il n’y avait également pas de différence significative en termes de complications tardives, type de récidive, survie globale et survie sans récidive. La sécurité oncologique, attestée par les limites de résections et le nombre de ganglions prélevés, n’était pas significativement différente entre les deux groupes. Le temps opératoire était significativement plus long en laparoscopie (p < 0,001). Le taux de conversion était de 33%. Il est passé de 67% au cours des 2 premières années de l’étude à 13% au cours des 2 dernières années. La conversion de la laparoscopie en laparotomie n’avait pas d’impact significatif ni sur les suites opératoires précoces, ni sur la survie globale et la survie sans récidive.ConclusionLa voie laparoscopique est une voie d’abord ayant des résultats à court et à long terme au moins équivalents à la laparotomie. La courbe d’apprentissage représentant un « passage obligé » n’a pas d’impact négatif sur les résultats du traitement laparoscopique des cancers coliques non métastatiques.

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The learning curve for laparoscopic colectomy in colorectal cancer at a new regional hospital

Abstract: Laparoscopic colectomy for colorectal cancer in a new regional hospital is feasible and safe. It does not need additional time for learning. Laparoscopic sigmoidectomy can be considered as the initial surgery for a trainee.

Cited by 21 publications

References 24 publications

Reduction in the Frequency of Scope Contamination During Laparoscopic Surgery Correlates with Scope Operator Experience

Reduction in the Frequency of Scope Contamination During Laparoscopic Surgery Correlates with Scope Operator Experience

Transitional impact of short‐ and long‐term outcomes of a randomized controlled trial to evaluate laparoscopic versus open surgery for colorectal cancer from Japan Clinical Oncology Group Study JCOG0404

Colectomie laparoscopique versus colectomie par laparotomie dans le traitement des adénocarcinomes coliques non métastatiques

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