Yanan Wang, Phd, Junmeng Li, MD, Tingyu Mou, Phd, Dong Liu, MD, Haijun Deng, Phd, Guoxin Li, Phd. Department of General Surgery, Nanfang Hospital, Southern Medical University
Background Single-incision plus one port (SILS + 1) surgery possesses minimally invasive advantages such as less postoperative pain, faster postoperative recovery, shorter hospital stay, and better cosmetic results compared with conventional five-port laparoscopic surgery, meanwhile, it’s less technical demanding and easier to access compared with pure single-incision laparoscopic surgery. The aim of this study was to investigate the learning curve for single-incision plus one port laparoscopic surgery for rectosigmoid cancer and to compare the learning curve phases in terms of perioperative clinicopathologic outcomes.
Methods From Jan 2013 to Mar 2015, a series of 85 consecutive patients underwent selective SLIS+1 for rectosigmoid cancer by a surgeon who had experience of more than 100 cases of conventional five-port laparoscopic surgeries at Nanfang Hospital, Southern Medical University. The learning curve for SILS + 1 was evaluated using moving average, cumulative sum control chart (CUSUM), and risk-adjusted CUSUM (RA-CUSUM) methods. For risk-adjusted CUSUM, surgical failure was defined as conversion, postoperative complication within 30 days, retrieved lymph nodes < 12, or local recurrence through follow-up. Data of all the perioperative variables and pathologic results among the learning curve phases were compared.
Results Combining the results from CUSUM and RA-CUSUM methods, the learning curve was determined as three phases: phase 1 (case 1 – 14) as the initial learning period; phase 2 (case 15 – 44) as the learning plateau period; phase 3 (case 45 – 85) as the competent period. The RA-CUSUM curve did not ascend after 44th case, which suggested technical competence to satisfy feasible perioperative outcomes. The total operating time (120.1 vs 97.0 vs 91.6 mins, p = 0.001) and intraperitoneal operating time (80.5 vs 62.1 vs 58.3 mins, p = 0.002) both decreased significantly after phase 1. The time to first flatus was significantly different between phase 2 and 3 (63.9 vs 48.1 hours; p = 0.004). The number of harvested lymph nodes increased accordingly with the surgeon’s experience escalating (14.4 vs 20.2 vs 25.1; p < 0.001). There were no significant differences in terms of rates of conversion, local recurrence or postoperative complications among the learning phases.
The learning curve of SILS + 1 for rectosigmoid colon cancer consisted of three phases. According to the CUSUM and RA-CUSUM, for experienced conventional five-port laparoscopic surgeon, after 14th case the learning process reached the plateau period, and the technical competence was achieved after the 44th case.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78711
Program Number: P210
Presentation Session: Poster (Non CME)
Presentation Type: Poster