Division of General Surgery, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy.
Department of Minimally Invasive and Robotic Surgery, "F. Miulli" Regional General Hospital, Acquaviva delle Fonti (BA), Italy.
ANZ J Surg. 2021 Sep;91(9):E554-E560. doi: 10.1111/ans.17021. Epub 2021 Jun 28.
Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear.
A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the learning curve of laparoscopic cholecystectomy were included. The Newcastle-Ottawa scale for cohort studies and the GRADE scale were used for the quality assessment of the selected articles.
Nine cohort studies published between 1991 and 2020 were included. All studies showed a great heterogeneity among the considered variables. Seven articles (77.7%) assessed intraoperative variables only, without considering patient's characteristics, operator's experience, and grade of gallbladder inflammation. Only five articles (55%) provided a precise cut-off value to see proficiency in the learning curve, ranging from 13 to 200 laparoscopic cholecystectomies.
The lack of clear guidelines when evaluating the learning curve in surgery, probably contributed to the divergent data and heterogeneous results among the studies. The development of guidelines for the investigation and reporting of a surgical learning curve would be helpful to obtain more objective and reliable data especially for common operation such as laparoscopic cholecystectomy.
腹腔镜胆囊切除术是全球开展最多的手术之一，但它的学习曲线仍不清楚。
根据 2009 年系统评价和荟萃分析首选报告项目的指南，进行了系统评价。两名独立的审查员通过在线数据库（包括 Medline、Scopus、Embase 和 Google Scholar）系统地搜索文献。纳入了研究腹腔镜胆囊切除术学习曲线的人类研究。使用新的卡斯尔 - 渥太华队列研究量表和 GRADE 量表对所选文章进行质量评估。
纳入了 1991 年至 2020 年期间发表的 9 项队列研究。所有研究都显示出所考虑变量之间存在很大的异质性。7 篇文章（77.7%）仅评估了术中变量，而没有考虑患者特征、手术者经验和胆囊炎症程度。只有 5 篇文章（55%）提供了精确的学习曲线熟练程度的截止值，范围从 13 到 200 例腹腔镜胆囊切除术。
在评估手术学习曲线时缺乏明确的指南，可能导致研究之间的数据分歧和结果不一致。制定调查和报告手术学习曲线的指南将有助于获得更客观和可靠的数据，特别是对于腹腔镜胆囊切除术等常见手术。
