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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  ;  Nam Kyu Kim 
 Journal of the American College of Surgeons, Vol.221(2) : 397-403, 2015 
Journal Title
 Journal of the American College of Surgeons 
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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 65(th) case (173 minutes). The CUSUM method also showed the operation time peak point at the 65(th) 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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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실)
Yonsei Authors
강정현(Kang, Jeonghyun) ORCID logo https://orcid.org/0000-0001-7311-6053
김남규(Kim, Nam Kyu) ORCID logo https://orcid.org/0000-0003-0639-5632
김우람(Kim, Woo Ram)
김하얀(Kim, Ha Yan)
민병소(Min, Byung Soh)
백승혁(Baik, Seung Hyuk)
이강영(Lee, Kang Young)
허혁(Hur, Hyuk) ORCID logo https://orcid.org/0000-0002-9864-7229
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