The learning curve for single-incision laparoscopic colectomy for colon cancer: succession of surgical techniques for novice surgeons.

PURPOSE

Single-incision laparoscopic surgery (SILS) for colon cancer is technically challenging for novice surgeons. Although it has been shown to be safe and feasible, the learning curve (LC) among novices has not been characterized. The present study investigated the LC for SILS based on data from several novice surgeons.

METHODS

We retrospectively reviewed consecutive cases of SILS-ileocecal resection (SILS-ICR) performed by two experienced and three novice surgeons from May 2009 to March 2020. A cumulative sum (CUSUM) analysis was used to analyze the learning curve and evaluate SILS completion. In addition, a statistical model was created to clarify the difference between the operation times of novices (Surgeons C, D, and E) and experienced surgeons (Surgeons A and B), estimating the operative time and risk estimation model.

RESULTS

Two experienced surgeons and three novice surgeons performed 187 and 103 SILS-ICRs, respectively. A CUSUM analysis showed LCs of 20, 18, and 20 cases for Surgeons C, D, and E, respectively, suggesting that novice surgeons would achieve results comparable to those of experienced surgeons in 39, 47, and 36 cases, respectively.

CONCLUSIONS

In SILS-ICR, novice surgeons reached the nadir in 18-20 cases and reached the level of experienced surgeons in 36-47 cases.