Li Xingwang, Guo Shaoqing, Yao Kunhou, Ge Zheng, Li Yuewei, Hu Junhong, Xia Hongping
Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China.
Department of General Surgery, Huaihe Hospital Affiliated to Henan University, Henan, China.
Front Oncol. 2025 Mar 25;15:1545589. doi: 10.3389/fonc.2025.1545589. eCollection 2025.
The field of view through transanal endoscopic provides new treatment approaches for solving complex clinical problems. TAMIS belongs to single-port endoscopic surgery, and the operation is complex. Analyzing the learning curve of TAMIS aims to facilitate its better clinical promotion.
A retrospective cohort study analyzed the clinical data of 58 patients who underwent TAMIS by the same surgeon from January 2018 to October 2024. The learning curve of TAMIS was obtained using the cumulative sum (CUSUM) analysis, and the optimal number of surgeries was determined based on the peak value of the curve, Clinical indicators such as operative time, intraoperative blood loss, positive rate of circumferential margin, length of postoperative hospital stay, and incidence of postoperative complications were compared at different stages.
All 58 patients successfully underwent TAMIS. The optimum curve equation was y=0.016 -2.0556 +67.240-150.103, = 0.950, <0.05. According to the peak value of the curve, 22 cases were determined as the minimum cumulative required cases for surgeons to cross the TAMIS learning curve. 58 cases were divided into two groups: the learning improvement group (Pre-proficiency) of the first 22 cases, and the proficiency group (Post-proficiency) of the latter 36 cases. Compared with Pre-proficiency stage, the Post-proficiency stage had shorter surgery duration, less intraoperative blood loss, and shorter length of postoperative hospital stay (<0.05). There was no statistically significant difference in the observation indicators including positive rate of circumferential margin and incidence of postoperative complications between the two groups (>0.05).
The learning curve of TAMIS can be divided into Pre-proficiency stage and Post-proficiency stage. 22 surgeries may be the number of surgeries required to cross the TAMIS learning curve.
经肛门内镜的视野为解决复杂临床问题提供了新的治疗方法。经肛门微创手术标本取出术（TAMIS）属于单孔内镜手术，操作复杂。分析TAMIS的学习曲线旨在促进其更好地在临床推广。
一项回顾性队列研究分析了2018年1月至2024年10月间由同一位外科医生实施TAMIS手术的58例患者的临床资料。采用累积和（CUSUM）分析获得TAMIS的学习曲线，并根据曲线峰值确定最佳手术例数，比较不同阶段的手术时间、术中出血量、环周切缘阳性率、术后住院时间及术后并发症发生率等临床指标。
58例患者均成功完成TAMIS手术。最佳曲线方程为y = 0.016 - 2.0556 + 67.240 - 150.103，r = 0.950，P < 0.05。根据曲线峰值，确定22例为外科医生跨越TAMIS学习曲线所需的最小累积病例数。58例患者分为两组：前22例为学习提高组（熟练前），后36例为熟练组（熟练后）。与熟练前阶段相比，熟练后阶段手术时间更短、术中出血量更少、术后住院时间更短（P < 0.05）。两组间环周切缘阳性率、术后并发症发生率等观察指标差异无统计学意义（P > 0.05）。
TAMIS的学习曲线可分为熟练前阶段和熟练后阶段。22例手术可能是跨越TAMIS学习曲线所需的手术例数。
