Trainee competence in thoracoscopic esophagectomy in the prone position: evaluation using cumulative sum techniques

Area of Science:

• Surgical innovation
• Minimally invasive surgery
• Medical education

Background:

• Minimally invasive esophagectomy (MIE) offers reduced morbidity compared to open procedures.
• Thoracoscopic esophagectomy in the prone position (TEP) is a globally adopted MIE technique.

Purpose of the Study:

• To evaluate if a trainee surgeon, following established standards, can achieve TEP proficiency with a shorter learning curve than the mentoring surgeon.
• To assess the utility of the cumulative sum control chart (CUSUM) method in evaluating surgical competence.

Main Methods:

• Surgeon A (mentor) performed 100 TEP procedures; the first 22 (period 1) were analyzed.
• The learning curve for Surgeon A was assessed using CUSUM based on thoracic procedure operation time (OT).
• Surgeon B (trainee) underwent 22 TEP procedures, with outcomes compared to Surgeon A's initial 22 cases.

Main Results:

• The CUSUM method identified the peak learning curve for Surgeon A at case 44; Surgeon A's initial 22 cases showed an unconfirmed learning curve.
• Surgeon B's CUSUM chart indicated a peak learning curve at case 17.
• Surgeon B demonstrated a significantly lower rate of recurrent laryngeal nerve palsy (9%) compared to Surgeon A in period 1 (36%).

Conclusions:

• Trainee surgeons can acquire essential TEP skills relatively quickly using standardized procedures from experienced surgeons.
• The CUSUM method is a valuable tool for assessing trainee surgeon competence during the initial learning phase, particularly by analyzing operation time.