Learning curves for single incision and conventional laparoscopic right hemicolectomy: a multidimensional analysis

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Conventional laparoscopic right hemicolectomy (CL RHC) is a standard surgical procedure.
• Single incision laparoscopic right hemicolectomy (SIL RHC) offers potential cosmetic and ergonomic benefits.
• Comparing learning curves and early outcomes is crucial for adopting new surgical techniques.

Purpose of the Study:

• To compare the learning curves of conventional laparoscopic (CL) and single incision laparoscopic (SIL) right hemicolectomy (RHC).
• To evaluate and compare early postoperative outcomes between CL RHC and SIL RHC.

Main Methods:

• Retrospective analysis of the initial 35 cases for both CL RHC and SIL RHC.
• Learning curve assessment using moving average operative time, mean operative time per five cases, and cumulative sum (CUSUM) analysis.
• Definition of learning phase completion based on operative time stabilization.

Main Results:

• Learning phase completion: SIL RHC (26-30 cases), CL RHC (16-20 cases) by mean operative time.
• Moving average analysis indicated ~31 SIL RHC and ~25 CL RHC cases needed.
• CUSUM analysis showed 10 SIL RHC and 2 CL RHC cases for steady complication-free performance.
• SIL RHC had a higher postoperative complication rate (17.1%) than CL RHC (3.4%), not statistically significant.

Conclusions:

• The learning curve for SIL RHC is demonstrably longer than for CL RHC.
• Early oncological outcomes were comparable between the two surgical approaches.
• SIL RHC exhibited a higher, though not statistically significant, complication rate during its learning phase compared to CL RHC.