Learning curve for single-incision laparoscopic surgery for colon cancer: A multicenter observational study

Suk-Hwan Lee, MD1, Byung Mo Kang, MD2, Bong Hyeon Kye, MD3, Chang Woo Kim, MD1, Hyung Jin Kim, MD3, Sun Jin Park, MD4, Kil Yeon Lee, MD4, Sang Chul Lee, MD5, Yoon Suk Lee, MD6, Sang Woo Lim, MD7. 1Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea, 2Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea, 3St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea, 4Kyung Hee Medical Center, Kyung Hee University School of Medicine, Seoul, Korea, 5Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea, 6Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea, 7Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea

Purpose: Single-incision laparoscopic surgery (SILS) was known to be ergonomically uncomfortable and technically difficult for even experienced-surgeons, although it has a better cosmetic benefit from smaller incision than conventional laparoscopic surgery (CLS). The aim of this study is to investigate the learning curves for SILS for colorectal cancer of various surgeons from a multicenter database.

Methods: Data were collected from two different studies. From May 2009 through June 2012, Korean SIMPLE study group performed a retrospective analysis of SILS for colorectal cancer in Korea. From August 2012 to now, they have conducted a randomized-controlled, multicenter trial comparing SILS and CLS. Finally, a total of 406 patients underwent SILS for colorectal cancer by eleven surgeons from ten institutions. Among them, the data over 20 cases performed by each surgeon were included. The learning curves were analyzed using the moving average method and the cumulative sum control chart (CUSUM).

Results: Learning curves for anterior resection by 6 surgeons and right hemicolectomy by 3 surgeons were analyzed. The moving average and CUSUM for anterior resection of indicated that most experienced-surgeons need to 14-36 cases to overcome the learning curve. However, one surgeon did not show stable operation time during his 42 cases. On the other hand, the learning curves for right hemicolectomy were ambiguous for two surgeons, whereas one surgeon needed 15 cases to achieve technical stability.

Conclusion: The learning curves of SILS were various in this study. The short-term outcomes were feasible and stable after 14th-36th cases by some surgeons, while the learning curves by others appeared ambiguous. SILS can be applicable to colorectal cancer for surgeons who experienced CLS, although it has some uncomfortable characteristics.

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