title: Learning curve for single-incision laparoscopic resection of right-sided colon cancer by complete mesocolic excision.
abstract: Single-incision laparoscopic surgery is cosmetically beneficial, but technically challenging. In this study, the learning curve (LC) for single-incision laparoscopic right hemicolectomy (SILRC), incorporating complete mesocolic excision to resect right-sided colon cancer, was investigated through multidimensional techniques. Between December 2009 and May 2015, 64 patients each underwent SILRC of right-sided colon cancer at Severance Hospital, performed in all instances by the same surgeon. Moving average and cumulative sum control chart (CUSUM) were used for LC analyses retrospectively. Surgical failure was defined as conversion to conventional laparoscopic surgery, postsurgical morbidity within 30 days, harvested lymph node count <12, or local tumor recurrence. Both moving average and CUSUM graphics of operative time registered nadirs at the 24th patient, with slight ascent thereafter, reaching a plateau at the 40th patient. The CUSUM for surgical success peaked at the 23rd patient. Operative time for 23 patients in phase 1 (1-23) and for 41 patients in phase 2 (24-64) of the LC did not differ significantly. By comparison, significant differences in patients of phase 2 included larger tumor size, higher harvested lymph node counts, longer proximal resection margins, and more advanced disease. As indicated by multidimensional statistical analyses, the LC for SILRC of right-sided colon cancer was 23 patients. In terms of operative time and surgical success, SILRC is feasible for surgeons experienced in LS, but may prove more challenging for novices, given the fundamental technical difficulties of this procedure.
authors.affiliation: aDivision of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine bBiostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Chang Woo
authors.initials: CW
authors.lastname: Kim
authors.forename: Yun Dae
authors.initials: YD
authors.lastname: Han
authors.forename: Ha Yan
authors.initials: HY
authors.lastname: Kim
authors.forename: Hyuk
authors.initials: H
authors.lastname: Hur
authors.forename: Byung Soh
authors.initials: BS
authors.lastname: Min
authors.forename: Kang Young
authors.initials: KY
authors.lastname: Lee
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods*; D059032:Learning Curve; D008297:Male; D008646:Mesocolon / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies