Ann Surg Treat Res.  2015 May;88(5):269-275. 10.4174/astr.2015.88.5.269.

Learning curves for single incision and conventional laparoscopic right hemicolectomy: a multidimensional analysis

• Park Y
• Yong YG
• Yun SH
• Jung KU
• Huh JW
• Cho YB
• Kim HC
• Lee WY
• Chun HK

• KMID: 2166995
• DOI: http://doi.org/10.4174/astr.2015.88.5.269

Abstract

PURPOSE
This study aimed to compare the learning curves and early postoperative outcomes for conventional laparoscopic (CL) and single incision laparoscopic (SIL) right hemicolectomy (RHC).
METHODS
This retrospective study included the initial 35 cases in each group. Learning curves were evaluated by the moving average of operative time, mean operative time of every five consecutive cases, and cumulative sum (CUSUM) analysis. The learning phase was considered overcome when the moving average of operative times reached a plateau, and when the mean operative time of every five consecutive cases reached a low point and subsequently did not vary by more than 30 minutes.
RESULTS
Six patients with missing data in the CL RHC group were excluded from the analyses. According to the mean operative time of every five consecutive cases, learning phase of SIL and CL RHC was completed between 26 and 30 cases, and 16 and 20 cases, respectively. Moving average analysis revealed that approximately 31 (SIL) and 25 (CL) cases were needed to complete the learning phase, respectively. CUSUM analysis demonstrated that 10 (SIL) and two (CL) cases were required to reach a steady state of complication-free performance, respectively. Postoperative complications rate was higher in SIL than in CL group, but the difference was not statistically significant (17.1% vs. 3.4%).
CONCLUSION
The learning phase of SIL RHC is longer than that of CL RHC. Early oncological outcomes of both techniques were comparable. However, SIL RHC had a statistically insignificant higher complication rate than CL RHC during the learning phase.

Keyword

Single-incision; Laparoscopy; Colectomy; Learning curve; CUSUM

MeSH Terms

Colectomy
Humans
Laparoscopy
Learning
Learning Curve*
Operative Time
Postoperative Complications
Retrospective Studies

Figure

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  Fig. 1 Moving average of operative times for SIL RHC and CL RHC. SIL RHC, single incision-laparoscopic right hemicolectomy; CL, conventional laparoscopic.

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  Fig. 2 Mean operative time of every five consecutive cases of SIL RHC and CL RHC. SIL RHC, single incision-laparoscopic right hemicolectomy; CL, conventional laparoscopic.

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  Fig. 3 CUSUM curves of SIL RHC and CL RHC. CUSUM, cumulative sum analysis; SIL RHC, single incision-laparoscopic right hemicolectomy; CL, conventional laparoscopic.

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