Elisa Reitano1, Nicola de'Angelis2, Elena Schembari3, Maria Clotilde Carrà4,5, Elisa Francone6, Sergio Gentilli6, Gaetano La Greca3. 1. Division of General Surgery, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy. 2. Department of Minimally Invasive and Robotic Surgery, "F. Miulli" Regional General Hospital, Acquaviva delle Fonti (BA), Italy. 3. Department of Biomedical and Biotechnological sciences, University of Catania, Catania, Italy. 4. Department of Odontology, Rothschild University Hospital, Paris, France. 5. University Paris Diderot, Paris, France. 6. Division of General Surgery, Department of Health Science, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy.
Abstract
BACKGROUND: Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear. METHODS: A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the learning curve of laparoscopic cholecystectomy were included. The Newcastle-Ottawa scale for cohort studies and the GRADE scale were used for the quality assessment of the selected articles. RESULTS: Nine cohort studies published between 1991 and 2020 were included. All studies showed a great heterogeneity among the considered variables. Seven articles (77.7%) assessed intraoperative variables only, without considering patient's characteristics, operator's experience, and grade of gallbladder inflammation. Only five articles (55%) provided a precise cut-off value to see proficiency in the learning curve, ranging from 13 to 200 laparoscopic cholecystectomies. CONCLUSIONS: The lack of clear guidelines when evaluating the learning curve in surgery, probably contributed to the divergent data and heterogeneous results among the studies. The development of guidelines for the investigation and reporting of a surgical learning curve would be helpful to obtain more objective and reliable data especially for common operation such as laparoscopic cholecystectomy.
BACKGROUND: Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear. METHODS: A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the learning curve of laparoscopic cholecystectomy were included. The Newcastle-Ottawa scale for cohort studies and the GRADE scale were used for the quality assessment of the selected articles. RESULTS: Nine cohort studies published between 1991 and 2020 were included. All studies showed a great heterogeneity among the considered variables. Seven articles (77.7%) assessed intraoperative variables only, without considering patient's characteristics, operator's experience, and grade of gallbladder inflammation. Only five articles (55%) provided a precise cut-off value to see proficiency in the learning curve, ranging from 13 to 200 laparoscopic cholecystectomies. CONCLUSIONS: The lack of clear guidelines when evaluating the learning curve in surgery, probably contributed to the divergent data and heterogeneous results among the studies. The development of guidelines for the investigation and reporting of a surgical learning curve would be helpful to obtain more objective and reliable data especially for common operation such as laparoscopic cholecystectomy.
Authors: Sebastian M Staubli; Peter Maloca; Christoph Kuemmerli; Julia Kunz; Amanda S Dirnberger; Andreas Allemann; Julian Gehweiler; Savas Soysal; Raoul Droeser; Silvio Däster; Gabriel Hess; Dimitri Raptis; Otto Kollmar; Markus von Flüe; Martin Bolli; Philippe Cattin Journal: Front Surg Date: 2022-08-12