Change point analysis validation of the learning curve in laparoscopic colorectal surgery: Experience from a non-structured training setting

BACKGROUNDThe introduction of minimal invasive principles in colorectal surgery was a major breakthrough, resulting in multiple clinical benefits, at the cost, though, of a notably steep learning process. The development of structured nation-wide training programs led to the easier completion of the learning curve; however, these programs are not yet universally available, thus prohibiting the wider adoption of laparoscopic colorectal surgery. AIMTo display our experience in the learning curve status of laparoscopic colorectal surgery under a non-structured training setting. METHODSWe analyzed all laparoscopic colorectal procedures performed in the 2012-2019 period under a non-structured training setting. Cumulative sum analysis and change-point analysis (CPA) were introduced. RESULTSOverall, 214 patients were included. In terms of operative time, CPA identified the 110th case as the first turning point. A plateau was reached after the 145th case. Subgroup analysis estimated the 58th for colon and 52nd case for rectum operations as the respective turning points. A learning curve pattern was confirmed for pathology outcomes, but not in the conversion to open surgery and morbidity endpoints. CONCLUSIONThe learning curves in our setting validate the comparability of the results, despite the absence of National or Surgical Society driven training programs.