Xu Zheng, Zhang Yueyang, Su Hao, Guan Xu, Liang Jianwei, Liu Qian, Wang Xishan, Zhou Haitao
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China.
Front Surg. 2023 Feb 13;10:1077472. doi: 10.3389/fsurg.2023.1077472. eCollection 2023.
Recently, totally laparoscopic ileostomy reversal (TLAP) has received increasing attention and exhibited promising short-term outcomes. The aim of this study was to detail the learning process of the TLAP technique.
Based on our initial experience with TLAP from 2018, a total of 65 TLAP cases were enrolled. Demographics and perioperative parameters were assessed using cumulative sum (CUSUM), moving average, and risk-adjusted CUSUM (RA-CUSUM) analyses.
The overall mean operative time (OT) was 94 min and the median postoperative hospitalization period was 4 days, and there was an estimated 10.77% incidence rate of perioperative complications. Three unique phases of the learning curve were derived from CUSUM analysis, and the mean OT of phase I (1-24 cases) was 108.5 min, that of phase II (25-39 cases) was 92 min, and that of phase III (40-65 cases) was 80 min, respectively. There was no significant difference in perioperative complications between these 3 phases. Similarly, moving average analysis indicated that the operation time was reduced significantly after the 20th case and reached a steady state after the 36th case. Furthermore, complication-based CUSUM and RA-CUSUM analyses indicated an acceptable range of complication rates during the whole learning period.
Our data demonstrated 3 distinct phases of the learning curve of TLAP. For an experienced surgeon, surgical competence in TLAP can be grasped at around 25 cases with satisfactory short-term outcomes.
近年来，完全腹腔镜回肠造口还纳术（TLAP）受到越来越多的关注，并展现出良好的短期效果。本研究旨在详细阐述TLAP技术的学习过程。
基于我们2018年以来TLAP的初步经验，共纳入65例TLAP病例。使用累积和（CUSUM）分析、移动平均分析和风险调整累积和（RA-CUSUM）分析评估人口统计学和围手术期参数。
总体平均手术时间（OT）为94分钟，术后中位住院时间为4天，围手术期并发症发生率估计为10.77%。通过CUSUM分析得出学习曲线的三个独特阶段，第一阶段（1 - 24例）的平均OT为108.5分钟，第二阶段（25 - 39例）为92分钟，第三阶段（40 - 65例）为80分钟。这三个阶段的围手术期并发症无显著差异。同样，移动平均分析表明，第20例手术后手术时间显著缩短，第36例手术后达到稳定状态。此外，基于并发症的CUSUM和RA-CUSUM分析表明，在整个学习期间并发症发生率在可接受范围内。
我们的数据展示了TLAP学习曲线的三个不同阶段。对于有经验的外科医生，大约完成25例TLAP手术就能掌握该手术技能，且短期效果良好。
