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Learning curve for transanal endoscopic microsurgery: a single-center experience.
Antonio Maya1, Andrew Vorenberg, Myrian Oviedo
1Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
Surgical Endoscopy
|December 25, 2013
Summary
The learning curve (LC) for transanal endoscopic microsurgery (TEM) shows significant improvement in operative time after just four cases. This minimally invasive technique becomes more efficient as surgeons gain experience.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Procedures
- Surgical Education
Background:
- Transanal endoscopic microsurgery (TEM) adoption was initially slow due to perceived difficulty and cost.
- The rise of laparoscopic colorectal surgery has spurred interest in TEM.
- Understanding the learning curve (LC) is crucial for TEM proficiency.
Purpose of the Study:
- To evaluate the learning curve (LC) for transanal endoscopic microsurgery (TEM).
- To quantify the impact of surgical experience on TEM operative efficiency.
Main Methods:
- Prospective database review of 23 TEM cases (2005-2008) by a single surgeon.
- Calculation of average rate of excision (ARE) in minutes per cm(2).
- Cumulative Sum (CUSUM) method used to plot the LC and assess changes in operative time.
Main Results:
- A significant decrease in ARE was observed after the first four TEM cases (13.8 vs. 7.9 min/cm(2), p=0.001).
- Operative time stabilized after approximately four cases, indicating proficiency.
- An additional learning plateau was noted after ten cases, correlating with increased resection of higher lesions.
Conclusions:
- The average rate of excision (ARE) significantly declines after the initial four transanal endoscopic microsurgery (TEM) cases.
- The learning curve for TEM demonstrates a substantial reduction in operative time following the first four procedures, highlighting the importance of experience.
