Learning curves in minimally invasive oncology

Unguryan V.M.; Kruglov E.A.; Pobedintseva Yu.A.

doi:https://doi.org/10.17116/endoskop20202604154

Close metadata

Recommended articles:

Experimental evaluation of a prototype robot-assisted system for minimally invasive abdominal surgery using radiofrequency ablation as an example. Endoscopic Surgery. 2024;(6):31-40

Comparative evaluation of the learning curve of lobectomies performed by open and video-assisted accesses. Endoscopic Surgery. 2025;(1):46-52

Immediate outcomes of simultaneous Cox-Maze procedure in patients with isolated and multivalvular heart defects via right mini-thoracotomy. Pirogov Russian Journal of Surgery. 2024;(12-2):18-24

CT in planning of heart valve surgery through minithoracotomy. Pirogov Russian Journal of Surgery. 2024;(12-2):127-133

Cost of supportive cancer care in the Russian Federation. Part 2. Medical Technologies. Assessment and Choice. 2024;(4):63-73

History creates man, and man creates history. On the 125th anniversary of the P.A. Herzen Moscow Oncology Research Institute. P.A. Herzen Journal of Oncology. 2024;(6):5-11

Use of a new tetrapeptide analgesic at the stages of antitumor therapy. P.A. Herzen Journal of Oncology. 2024;(6):23-32

Laparoscopic interventions in urgent surgery (literature review). Pirogov Russian Journal of Surgery. 2025;(2):94-101

Primary outcomes after major anatomical liver resections in infants at the National Children’s Medical Center. Pirogov Russian Journal of Surgery. 2025;(4):86-94

The first thousand of VATS anatomical lung resections at the Herzen Moscow Oncology Research Institute. Pirogov Russian Journal of Surgery. 2025;(6):7-18

Abstract:

The rapid development of endovideosurgical technologies every year affects more and more sections of clinical oncology. Currently, the most complex oncological surgery is performed using minimally invasive techniques. In this regard, the study of learning curves as a marker for the safe acquisition of knowledge of new medical technologies by doctors is a special role. At the same time, difficulties associated with the interpretation of data obtained as a result of constructing such graphs, and their comparison with other studies is remain. Unresolved is the question of choosing a criterion by which it is necessary to evaluate the success of the implementation of the new methodology. This review describes the concept of the development of learning curves in minimally invasive oncological surgery, considers various forms of learning curves, suggests methods with which you can build learning curves and describe their compliance with modern medical practice.

Keywords:

oncology

minimally invasive surgery

endovideosurgery

learning curve

Authors:

Unguryan V.M.

Kostroma Oncology Center

ORCID: 0000-0003-2094-0596

Kruglov E.A.

Kostroma Oncology Dispensary

Pobedintseva Yu.A.

Kostroma Oncology Dispensary

Received:

01.09.2019

Accepted:

21.05.2020

Close metadata

References:

Hassan A, Pozzi M, Hamilton L. New surgical procedures: can we minimise the learning curve? BMJ. 2000;320(7228):171-173. https://doi.org/10.1136/bmj.320.7228.171
Cook JA, Ramsay CR, Fayers P. Using the literature to quantify the learning curve: a case study. Int J Technol Assess Health Care. 2007;23(2):255-260. https://doi.org/10.1017/S0266462307070341
Roh HF, Nam SH, Kim JM. Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: A systematic review and meta-analysis. PLoS One. 2018;13(1):e0191628. https://doi.org/10.1371/journal.pone.0191628
Schout BM, Hendrikx AJ, Scherpbier AJ, Bemelmans BL. Update on training models in endourology: a qualitative systematic review of the literature between January 1980 and April 2008. Eur Urol. 2008;54(6):1247-1261. https://doi.org/10.1016/j.eururo.2008.06.036
Machenzie H. National proficiency-gain curves for minimally invasive gastrointestinal cancer surgery. Br J Surg. 2016;103(1):88-96. https://doi.org/10.1002/bjs.9963
McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, Nicholl J; Balliol Collaboration, Aronson JK, Barkun JS, Blazeby JM, Boutron IC, Campbell WB, Clavien PA, Cook JA, Ergina PL, Feldman LS, Flum DR, Maddern GJ, Nicholl J, Reeves BC, Seiler CM, Strasberg SM, Meakins JL, Ashby D, Black N, Bunker J, Burton M, Campbell M, Chalkidou K, Chalmers I, de Leval M, Deeks J, Ergina PL, Grant A, Gray M, Greenhalgh R, Jenicek M, Kehoe S, Lilford R, Littlejohns P, Loke Y, Madhock R, McPherson K, Meakins J, Rothwell P, Summerskill B, Taggart D, Tekkis P, Thompson M, Treasure T, Trohler U, Vandenbroucke J. No surgical innovation without evaluation: the IDEAL recommendations. Lancet. 2009;374(9695):1105-1112. https://doi.org/10.1016/S0140-6736(09)61116-8
Evrard S. Rethinking clinical research in surgical oncology. From comic opera to quality control. Bull Cancer. 2016;103(1):87-95. [In French]. https://doi.org/10.1016/j.bulcan.2015.10.006
Wright TP. Factors Affecting the Cost of Airplanes. J Aeronaut Scie. 1936;3(4):122-128. https://doi.org/10.2514/8.155
Jackson CR, Gibbin KP. ‘Per ardua...’ Training tomorrow’s surgeons using inter alia lessons from aviation. J R Soc Med. 2006;99(11):554-558. https://doi.org/10.1258/jrsm.99.11.554
Park IJ, Choi GS, Lim KH, Kang BM, Jun SH. Multidimensional analysis of the learning curve for laparoscopic colorectal surgery: lessons from 1,000 cases of laparoscopic colorectal surgery. Surg Endosc. 2009;23(4):839-846. https://doi.org/10.1007/s00464-008-0259-4
Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM; COlon cancer Laparoscopic or Open Resection Study Group (COLOR) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477-484. https://doi.org/10.1016/S1470-2045(05)70221-7
Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT. Assessment of the learning curve in health technologies. A systematic review. Int J Technol Assess Health Care. 2000;16(4):1095-1108.
Eyers T. Laparoscopic and other colorectal trials: ethics pf the learning curve. ANZ J Surg. 2017;87(11):859. https://doi.org/10.1111/ans.14165
Hopper A.N., Jamison MH, Lewis WG. Learning curves in surgical practice. Postgrad Med J. 2007;83(986):777-779. https://doi.org/10.1136/pgmj.2007.057190
Bingener-Casey J, Richards ML, Strodel WE, Schwesinger WH, Sirinek KR. Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review. J Gastrointest Surg. 2002;6(6):800-805.
Westerman SJ, Davies DR. Acquisition and application of new technology skills: the influence of age. Occup Med (Lond). 2000;50(7):478-482. https://doi.org/10.1093/occmed/50.7.478
Khan N. Measuring the surgical «learning curve»: methods, variables and competency. BJU Int. 2014;113(3):504-508. https://doi.org/10.1111/bju.12197
Harrysson IJ, Cook J, Sirimanna P, Feldman LS, Darzi A, Aggarwal R. Systematic review of learning curves for minimally invasive abdominal surgery: a review of the methodology of data collection, depiction of outcomes, and statistical analysis. Ann Surg. 2014;260(1):37-45. https://doi.org/10.1097/SLA.0000000000000596
Grantcharov TP, Reznick RK. Teaching procedural skills. BMJ. 2008; 336:1129-1131. https://doi.org/10.1136/bmj.39517.686956.47
Claassen L, van Workum F, Rosman C. Learning curve and postoperative outcomes of minimally invasive esophagectomy. J Thorac Dis. 2019;11(5):777-785. https://doi.org/10.21037/jtd.2018.12.54
Zhu ZY, Yong X, Luo RJ, Wang YZ. Clinical analysis of minimally invasive McKeown esophagectomy in a single center by a single medical group. J Zhejiang Univ Sci B. 2018;19(9):718-725. https://doi.org/10.1631/jzus.B1800329
Moon JS, Park MS, Kim JH, Jang YJ, Park SS, Mok YJ, Kim SJ, Kim CS, Park SH. Lessons learned from a comparative analysis of surgical outcomes of and learning curves for laparoscopy-assisted distal gastrectomy. J Gastric Cancer. 2015;15(1):29-38. https://doi.org/10.5230/jgc.2015.15.1.29
Chi KC, Park JM. Laparoscopic gastrectomy performed by an expert in open gastrectomy. J Gastric Cancer. 2017;17(3):237-245. https://doi.org/10.5230/jgc.2017.17.e30
Tyutyunnik PS, Khatkov IE, Tsvirkun VV, Izrailov RE, Khisamov AA, Andrianov AV. Optimal model of learning curve through the example of laparoscopic pancreatoduodenectomy. Endoskopicheskaya khirurgiya. 2015; 21(5):45-49. (In Russ.) https://doi.org/10.17116/endoskop201521545-49
Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg. 2010;145(1):19-23. https://doi.org/10.1001/archsurg.2009.243
Tekkis PP, Senagore AJ, Delaney CP, Fazio VW. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right sided and left sided resections. Ann Surg. 2005;242(1):83-91. https://doi.org/10.1097/01.sla.0000167857.14690.68
Dincler S, Koller MT, Steurer J, Bachmann LM, Christen D, Buchmann P. Multidimensional analysis of learning curve in laparoscopic sigmoid resection: 8-year results. Dis Colon Rectum. 2003;46(10):1278-1279. https://doi.org/10.1007/s10350-004-6752-5
Li JC, Hon SS, Ng SS, Lee JF, Yiu RY, Leung KL. The learning curve for laparoscopic colectomy: experience of a surgical fellow in a university colorectal unit. Surg Endosc. 2009;23(7):1603-1608. https://doi.org/10.1007/s00464-009-0497-0
Ghomi A. Assessing the learning curve for laparoscopic supracervical hysterectomy. JSLS. 2007;11(2):190-194.
Bojahr B, Raatz D, Schonleber, Abri C, Ohlinger R. Perioperative complication rate in 1706 patients after a standardized laparoscopic supracervical hysterectomy technique. J Minim Invasive Gynecol. 2006;13(3):183-189. https://doi.org/10.1016/j.jmig.2006.01.010
Soulie M, Seguin P, Richeux L, Mouly P, Vazzoler N, Pontonnier F, Plante P. Urological complications of laparoscopic surgery: Experience with 350 procedures at a single center. J Urol. 2001;165:1960-1963.
Jha MS, Gupta N, Agrawal S, Ansari MS, Dubey D, Mandhani A, Srivastava A, Kumar A, Kapoor R. Single-centre experience of laparoscopic nephrectomy: Impact of learning curve on outcome. Indian J Urol. 2007; 23(3):253-256. https://doi.org/10.4103/0970-1591.33719
Kolozsvari NO, Kaneva P, Brace C, Chartrand G, Vaillancourt M, Cao J, Banaszek D, Demyttenaere S, Vassiliou MC, Fried GM, Feldman LS. Mastery versus the standard proficiency target for basic laparoscopic skill training: effect on skill transfer and retention. Surg Endosc. 2011;25(7):2063-2070. https://doi.org/10.1007/s00464-011-1743-9
Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287(2):226-235. https://doi.org/10.1001/jama.287.2.226
Bhatti NI, Cummings CW. Competency in surgical residency training: defining and raising the bar. Acad Med. 2007;82(6):569-573. https://doi.org/10.1097/ACM.0b013e3180555bfb
Wang Q, Wu Z, Chen G, Zhang S, Shen G, Wu M. Two-stage indicators to assess learning curves for minimally invasive Ivor Lewis esophagectomy. Thorac Cardiovasc Surg. 2018;66(5):362-369.
van Workum F, Stenstra MHBC, Berkelmans GHK. Learning curve and associated morbidity of minimally invasive esophagectomy: a retrospective multicenter study. Ann Surg. 2019;269:88-94. https://doi.org/10.1055/s-0036-1593408
Murashko RA, Ermakov EA, Uvarov IB. Robotic and laparoscopic surgeries for colorectal cancer: learning curve and short-term outcomes. Onkologicheskaya koloproktologiya. 2017;7(3):25-34. (In Russ.) https://doi.org/10.17650/2220-3478-2017-7-3-25-34
Grigg OA, Farewell VT, Spiegelhalter DJ. Use of risk‐adjusted CUSUM and RSPRT charts for monitoring in medical contexts. Stat Methods Med Res. 2003;12(2):147-170. https://doi.org/10.1177/096228020301200205
Biau DJ, Resche-Rigon M, Godiris-Petit G, Nizard RS, Porcher R. Quality control of surgical and interventional procedures: a review of the CUSUM. Qual Saf Health Care. 2007;16(3):203-207. https://doi.org/10.1136/qshc.2006.020776
Young A, Miller JP, Azarow K. Establishing learning curves for surgical residents using Cumulative Summation (CUSUM) Analysis. Curr Surg. 2005;62(3):330-334. https://doi.org/10.1016/j.cursur.2004.09.016
Okamura A, Watanabe M, Fukudome I, Yamashita K, Yuda M, Hayami M, Imamura Y, Mine S. Surgical team proficiency in minimally invasive esophagectomy is related to case volume and improves patient outcomes. Esophagus. 2018;15(2):115-121. https://doi.org/10.1007/s10388-018-0607-y
Toledano Trincado M, Sánchez Gonzalez J, Blanco Antona F, Martín Esteban ML, Colao García L, Cuevas Gonzalez J, Mayo Iscar A, Blanco Alvarez JI, Martín del Olmo JC. How to reduce the laparoscopic colorectal learning curve. JSLS. 2014;18(3). pii: e2014.0032. https://doi.org/10.4293/JSLS.2014.00321
Heo YJ, Kim S, Min KJ, Lee S, Hong JH, Lee JK, Lee NW, Song JY. The comparison of surgical outcomes and learning curves of radical hysterectomy by laparoscopy and robotic system for cervical cancer: an experience of a single surgeon. Obstet Gynecol Sci. 2018;61(4):468-467. https://doi.org/10.5468/ogs.2018.61.4.468
Harris C, Garrubba M, Allen K, King R, Kelly C, Thiagarajan M, Castleman B, Ramsey W, Farjou D. Development, implementation and evaluation of an evidence-based program for introduction of new health technologies and clinical practices in a local healthcare setting. BMC Health Serv Res. 2015;15:575. https://doi.org/10.1186/s12913-015-1178-4
Gottlieb-Vedi E, Mackenzie H, van Workum F, Rosman C, Lagergren P, Markar S, Lagergren J. Surgeon Volume and Surgeon age in relation to proficiency gain curvies for prognosis following surgery for esophageal cancer. Ann Surg Oncol. 2019;26(2):497-505. https://doi.org/10.1245/s10434-018-6869-8
Shanker BA, Soliman M, Williamson P, Ferrara A. Laparoscopic colorectal training gap in colorectal and surgical residents. JSLS. 2016;20(3). pii: e2016.00024. https://doi.org/10.4293/JSLS.2016.00024
Hsu KE, Man FY, Gizicki RA, Feldman LS, Fried GM. Experienced surgeons can do more than one thing at a time: effect of distraction on performance of a simple laparoscopic and cognitive task by experienced and novice surgeons. Surg Endosc. 2008;22(1):196-201. https://doi.org/10.1007/s00464-007-9452-0
Issenberg SB, McGaghie WC, Petrusa ER, Lee GD, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005;27(1):10-28. https://doi.org/10.1080/01421590500046924
Sutherland LM, Middleton PF, Anthony A, Hamdorf J, Cregan P, Scott D, Maddern GJ. Surgical simulation: a systematic review. Ann Surg. 2006; 243(3):291-300. https://doi.org/10.1097/01.sla.0000200839.93965.26
MacKenzie CL, Ibbotson JA, Cao CG, Lomax AJ. Hierarchical decomposition of laparoscopic surgery: a human factors approach to investigating the operating room environment. Minim Invasive Ther Allied Technol. 2001;10(3):121-127. https://doi.org/10.1080/136457001753192222