Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Surg Endosc. 2023 Oct;37(10):8133-8143. doi: 10.1007/s00464-023-10345-x. Epub 2023 Sep 8.
Laparoscopic cholecystectomy (LapC) is one of the most frequently performed surgical procedures worldwide. Reaching technical competency in performing LapC is considered one essential task for young surgeons. Investigating the learning curve for LapC (LC-LapC) may provide important information regarding the learning process and guide the training pathway of residents, improving educational outcomes. The present study aimed to investigate LC-LapC among general surgery residents (GSRs).
Operative surgical reports of consecutive patients undergoing LapC performed by GSRs attending the General Surgery Residency Program at the University of Milan were analysed. Data on patient- and surgery-related variables were obtained from the ICD-9-CM diagnosis codes and gathered. A multidimensional assessment of the LC was performed through Cumulative Sum (CUSUM) and Risk-Adjusted (RA)-CUSUM analysis.
340 patients operated by 6 GSRs were collected. The CUSUM and RA-CUSUM graphs based on surgical failures allowed to distinguish two defined phases for all GSRs: an initial phase ending at the peak, so-called learning phase, followed by a phase in which there was a significant decrease in failure incidence, so-called proficiency phase. The learning phase was completed for all GSRs at most within 25 procedures, but the trend of the curves and the number of procedures needed to achieve technical competency varied among operators ranging between 7 and 25.
The present study suggested that at most 25 procedures might be sufficient to acquire technical competency in LapC. The variability in the number of procedures needed to complete the LC, ranging between 7 and 25, could be due to the heterogeneous scenarios in which LapC was performed, and deserves to be investigated through a prospective study involving a larger number of GSRs and institutions.
腹腔镜胆囊切除术（LapC）是全球最常进行的手术之一。对于年轻外科医生来说，达到进行 LapC 的技术能力被认为是一项基本任务。研究腹腔镜胆囊切除术的学习曲线（LC-LapC）可以为学习过程提供重要信息，并指导住院医师的培训途径，从而提高教育效果。本研究旨在调查普通外科住院医师（GSRs）的 LC-LapC。
分析了在米兰大学普通外科住院医师培训计划中接受 LapC 手术的连续患者的手术报告。从 ICD-9-CM 诊断代码中获得了与患者和手术相关的变量的数据。通过累积总和（CUSUM）和风险调整（RA）-CUSUM 分析对 LC 进行多维评估。
共收集了 6 名 GSR 对 340 名患者进行的手术。基于手术失败的 CUSUM 和 RA-CUSUM 图可以区分所有 GSR 的两个定义阶段：初始阶段，即学习阶段，以峰值结束，随后是失败发生率显著下降的阶段，即熟练阶段。所有 GSR 的学习阶段都在最多 25 次手术内完成，但曲线的趋势和达到技术能力所需的手术次数因操作人员而异，范围在 7 到 25 次之间。
本研究表明，最多 25 次手术可能足以掌握 LapC 的技术能力。完成 LC 所需的手术次数（7 至 25 次之间）的差异可能是由于进行 LapC 的情况各异，这需要通过涉及更多 GSR 和机构的前瞻性研究来进一步探讨。
