Change point analysis validation of the learning curve in laparoscopic colorectal surgery: Experience from a non-structured training setting

BACKGROUND: The introduction of minimal invasive principles in colorectal surgery was a major breakthrough, resulting in multiple clinical benefits, at the cost, though, of a notably steep learning process. The development of structured nation-wide training programs led to the easier completion of the learning curve; however, these programs are not yet universally available, thus prohibiting the wider adoption of laparoscopic colorectal surgery. AIM: To display our experience in the learning curve status of laparoscopic colorectal surgery under a non-structured training setting. METHODS: We analyzed all laparoscopic colorectal procedures performed in the 2012-2019 period under a non-structured training setting. Cumulative sum analysis and change-point analysis (CPA) were introduced. RESULTS: Overall, 214 patients were included. In terms of operative time, CPA identified the 110(th) case as the first turning point. A plateau was reached after the 145(th) case. Subgroup analysis estimated the 58(th )for colon and 52(nd) case for rectum operations as the respective turning points. A learning curve pattern was confirmed for pathology outcomes, but not in the conversion to open surgery and morbidity endpoints. CONCLUSION: The learning curves in our setting validate the comparability of the results, despite the absence of National or Surgical Society driven training programs.