Perivoliotis K, Baloyiannis I, Mamaloudis I, Volakakis G, Valaroutsos A, Tzovaras G. Change point analysis validation of the learning curve in laparoscopic colorectal surgery: Experience from a non-structured training setting. World J Gastrointest Endosc 2022; 14(6): 387-401 [PMID: 35978712 DOI: 10.4253/wjge.v14.i6.387]
Corresponding Author of This Article
Ioannis Baloyiannis, MD, PhD, Assistant Professor, Department of Surgery, University Hospital of Larissa, Viopolis, Larissa 41110, Greece. balioan@hotmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jun 16, 2022; 14(6): 387-401 Published online Jun 16, 2022. doi: 10.4253/wjge.v14.i6.387
Change point analysis validation of the learning curve in laparoscopic colorectal surgery: Experience from a non-structured training setting
Konstantinos Perivoliotis, Ioannis Baloyiannis, Ioannis Mamaloudis, Georgios Volakakis, Alex Valaroutsos, George Tzovaras
Konstantinos Perivoliotis, Ioannis Baloyiannis, Ioannis Mamaloudis, Georgios Volakakis, Alex Valaroutsos, George Tzovaras, Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
Author contributions: Perivoliotis K, Baloyiannis I, and Tzovaras G designed the research study; Mamaloudis I, Volakakis G, and Valaroutsos A acquired the study data; Perivoliotis K and Baloyiannis I drafted the manuscript; Baloyiannis I and Tzovaras G critically revised and approved the final manuscript.
Institutional review board statement: This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. We consulted extensively with the IRB of University Hospital of Larissa who determined that our study did not need ethical approval since all procedures being performed were part of the routine care.
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: The datasets generated during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ioannis Baloyiannis, MD, PhD, Assistant Professor, Department of Surgery, University Hospital of Larissa, Viopolis, Larissa 41110, Greece. balioan@hotmail.com
Received: January 24, 2022 Peer-review started: January 24, 2022 First decision: April 17, 2022 Revised: April 23, 2022 Accepted: May 17, 2022 Article in press: May 17, 2022 Published online: June 16, 2022 Processing time: 139 Days and 10.8 Hours
Abstract
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 110th case as the first turning point. A plateau was reached after the 145th case. Subgroup analysis estimated the 58th for colon and 52nd 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.
Core Tip: In terms of operative time, the learning curve of a dedicated colorectal surgical team consists of three phases. Change point analysis identified the 110th case as the separation key-point of the first two phases. A plateau was reached after the 145th case. Although we were able to confirm the presence of a learning curve pattern in the histopathological endpoints, this was not the case for the open conversion and morbidity outcomes. Formal training program initiatives are necessary for the safe and efficient implementation of laparoscopic colorectal operations.
