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Multidimensional analyses of the learning curve for single‐incision plus one port laparoscopic surgery for sigmoid colon and upper rectal cancer
Author(s) -
Li Junmeng,
Wang Yanan,
Liu Dong,
Zhou Haipeng,
Mou Tingyu,
Li Guoxin,
Deng Haijun
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25029
Subject(s) - medicine , cusum , perioperative , surgery , sigmoid function , laparoscopic surgery , laparoscopy , colorectal cancer , sigmoid colon , colorectal surgery , general surgery , cancer , abdominal surgery , rectum , artificial intelligence , operations management , artificial neural network , computer science , economics
Background and Objectives Single‐incision plus one port surgery (SILS + 1) provides the advantages of being minimally invasive and easier to perform than pure single‐incision laparoscopic surgery. The aim of this study was to investigate the learning curve (LC) for SILS + 1 for sigmoid colon and upper rectal cancer. Method From November 2012 to May 2014, a series of 85 consecutive patients underwent selective SLIS + 1 for sigmoid colon and upper rectal cancer performed by a single surgeon at Nanfang Hospital. The LC for SILS + 1 was evaluated using cumulative sum control chart (CUSUM) and risk‐adjusted CUSUM methods. Data for all the perioperative variables and pathologic results among the phases were compared. Results The LC had three phases: phase 1 (cases 1‐13) was the initial learning period; phase 2 (cases 14‐44) was the learning plateau period; and phase 3 (cases 45‐85) was the competent period. The differences in total operating time among the three phases were significant. The number of harvested lymph nodes increased along with increases in the surgeon's experience. Conclusions For experienced CLS surgeons, the learning process reached the plateau period after the 13th case, and technical competence was achieved after the 44th case.