Learning Curve for Single-Incision Laparoscopic Anterior Resection for Sigmoid Colon Cancer

Chang Woo Kim, Woo Ram Kim, Ha Yan Kim, Jeonghyun Kang, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, Kang Young Lee, Namkyu Kim

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background Compared with conventional laparoscopic surgery, single-incision laparoscopic surgery produces better cosmetic benefits. The aim of this study was to investigate the learning curve for single-incision laparoscopic anterior resection (SILAR) for sigmoid colon cancer using multidimensional methods. Study Design From September 2009 through May 2014, one hundred and thirteen patients underwent SILAR for sigmoid colon cancer by a single surgeon at Severance Hospital. The learning curve was analyzed using moving average, cumulative sum control chart (CUSUM), and risk-adjusted CUSUM methods. For risk-adjusted CUSUM, surgical failure was defined as conversion to open surgery or conventional laparoscopic surgery, morbidity within 30 days after surgery, <12 harvested lymph nodes, or local recurrence. Results Using the moving average method, the peak point for operation time occurred at the 65th case (173 minutes). The CUSUM method also showed the operation time peak point at the 65th case. However, the risk-adjusted CUSUM curve did not ascend after the 61st case. The operation time and hospital stay for the 60 phase 1 patients (cases 1 to 60) were longer than for 53 phase 2 patients (cases 61 to 113) (166.6 vs 140 minutes; p < 0.001 and 7.1 vs 5.5 days; p = 0.009). Phase 2 patients had a significantly larger tumor diameter and more harvested lymph nodes. Conclusions The learning curve for SILAR for sigmoid colon cancer was 61 to 65 cases according to multidimensional statistical analyses. Single-incision laparoscopic anterior resection is feasible for surgeons experienced in laparoscopic surgery. However, SILAR required more cases for proficiency than the number previously reported for conventional laparoscopic surgery, likely because of its technical challenges.

Original languageEnglish
Pages (from-to)397-403
Number of pages7
JournalJournal of the American College of Surgeons
Volume221
Issue number2
DOIs
Publication statusPublished - 2015 Aug 1

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Sigmoid Neoplasms
Learning Curve
Laparoscopy
Lymph Nodes
Conversion to Open Surgery
Ambulatory Surgical Procedures
Cosmetics
Length of Stay
Morbidity
Recurrence
Neoplasms

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Kim, Chang Woo ; Kim, Woo Ram ; Kim, Ha Yan ; Kang, Jeonghyun ; Hur, Hyuk ; Min, Byung Soh ; Baik, Seung Hyuk ; Lee, Kang Young ; Kim, Namkyu. / Learning Curve for Single-Incision Laparoscopic Anterior Resection for Sigmoid Colon Cancer. In: Journal of the American College of Surgeons. 2015 ; Vol. 221, No. 2. pp. 397-403.
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abstract = "Background Compared with conventional laparoscopic surgery, single-incision laparoscopic surgery produces better cosmetic benefits. The aim of this study was to investigate the learning curve for single-incision laparoscopic anterior resection (SILAR) for sigmoid colon cancer using multidimensional methods. Study Design From September 2009 through May 2014, one hundred and thirteen patients underwent SILAR for sigmoid colon cancer by a single surgeon at Severance Hospital. The learning curve was analyzed using moving average, cumulative sum control chart (CUSUM), and risk-adjusted CUSUM methods. For risk-adjusted CUSUM, surgical failure was defined as conversion to open surgery or conventional laparoscopic surgery, morbidity within 30 days after surgery, <12 harvested lymph nodes, or local recurrence. Results Using the moving average method, the peak point for operation time occurred at the 65th case (173 minutes). The CUSUM method also showed the operation time peak point at the 65th case. However, the risk-adjusted CUSUM curve did not ascend after the 61st case. The operation time and hospital stay for the 60 phase 1 patients (cases 1 to 60) were longer than for 53 phase 2 patients (cases 61 to 113) (166.6 vs 140 minutes; p < 0.001 and 7.1 vs 5.5 days; p = 0.009). Phase 2 patients had a significantly larger tumor diameter and more harvested lymph nodes. Conclusions The learning curve for SILAR for sigmoid colon cancer was 61 to 65 cases according to multidimensional statistical analyses. Single-incision laparoscopic anterior resection is feasible for surgeons experienced in laparoscopic surgery. However, SILAR required more cases for proficiency than the number previously reported for conventional laparoscopic surgery, likely because of its technical challenges.",
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Learning Curve for Single-Incision Laparoscopic Anterior Resection for Sigmoid Colon Cancer. / Kim, Chang Woo; Kim, Woo Ram; Kim, Ha Yan; Kang, Jeonghyun; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Lee, Kang Young; Kim, Namkyu.

In: Journal of the American College of Surgeons, Vol. 221, No. 2, 01.08.2015, p. 397-403.

Research output: Contribution to journalArticle

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AU - Kim, Woo Ram

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AU - Lee, Kang Young

AU - Kim, Namkyu

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N2 - Background Compared with conventional laparoscopic surgery, single-incision laparoscopic surgery produces better cosmetic benefits. The aim of this study was to investigate the learning curve for single-incision laparoscopic anterior resection (SILAR) for sigmoid colon cancer using multidimensional methods. Study Design From September 2009 through May 2014, one hundred and thirteen patients underwent SILAR for sigmoid colon cancer by a single surgeon at Severance Hospital. The learning curve was analyzed using moving average, cumulative sum control chart (CUSUM), and risk-adjusted CUSUM methods. For risk-adjusted CUSUM, surgical failure was defined as conversion to open surgery or conventional laparoscopic surgery, morbidity within 30 days after surgery, <12 harvested lymph nodes, or local recurrence. Results Using the moving average method, the peak point for operation time occurred at the 65th case (173 minutes). The CUSUM method also showed the operation time peak point at the 65th case. However, the risk-adjusted CUSUM curve did not ascend after the 61st case. The operation time and hospital stay for the 60 phase 1 patients (cases 1 to 60) were longer than for 53 phase 2 patients (cases 61 to 113) (166.6 vs 140 minutes; p < 0.001 and 7.1 vs 5.5 days; p = 0.009). Phase 2 patients had a significantly larger tumor diameter and more harvested lymph nodes. Conclusions The learning curve for SILAR for sigmoid colon cancer was 61 to 65 cases according to multidimensional statistical analyses. Single-incision laparoscopic anterior resection is feasible for surgeons experienced in laparoscopic surgery. However, SILAR required more cases for proficiency than the number previously reported for conventional laparoscopic surgery, likely because of its technical challenges.

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