Tei Mitsuyoshi, Suzuki Yozo, Fujii Makoto, Ohtsuka Masahisa, Nomura Masatoshi, Yoshikawa Yukihiro, Tamai Koki, Sueda Toshinori, Akamatsu Hiroki, Matsuda Chu
Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Cho, Kita-Ku, Sakai City, , Osaka, 591-8025, Japan.
Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, Osaka, 543-0035, Japan.
Surg Today. 2025 Jun 22. doi: 10.1007/s00595-025-03071-5.
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.
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.
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.
In SILS-ICR, novice surgeons reached the nadir in 18-20 cases and reached the level of experienced surgeons in 36-47 cases.
对于新手外科医生而言，单切口腹腔镜手术（SILS）治疗结肠癌在技术上具有挑战性。尽管已证明其安全可行，但新手医生的学习曲线（LC）尚未明确。本研究基于多位新手外科医生的数据，对SILS的学习曲线进行了调查。
我们回顾性分析了2009年5月至2020年3月期间由两名经验丰富的外科医生和三名新手外科医生连续进行的SILS回盲部切除术（SILS-ICR）病例。采用累积和（CUSUM）分析来分析学习曲线并评估SILS手术的完成情况。此外，建立了一个统计模型，以阐明新手外科医生（C、D和E医生）与经验丰富的外科医生（A和B医生）手术时间的差异，估计手术时间和风险评估模型。
两名经验丰富的外科医生和三名新手外科医生分别进行了187例和103例SILS-ICR手术。CUSUM分析显示，C、D和E医生的学习曲线分别为20例、18例和20例，这表明新手外科医生分别在39例、47例和36例手术后可取得与经验丰富的外科医生相当的效果。
在SILS-ICR手术中，新手外科医生在18 - 20例手术时达到最低点，并在36 - 47例手术后达到经验丰富的外科医生的水平。
