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Learning curve for laparoscopic Heller myotomy and Dor fundoplication for achalasia.


ABSTRACT:

Purpose

Although laparoscopic Heller myotomy and Dor fundoplication (LHD) is widely performed to address achalasia, little is known about the learning curve for this technique. We assessed the learning curve for performing LHD.

Methods

Of the 514 cases with LHD performed between August 1994 and March 2016, the surgical outcomes of 463 cases were evaluated after excluding 50 cases with reduced port surgery and one case with the simultaneous performance of laparoscopic distal partial gastrectomy. A receiver operating characteristic (ROC) curve analysis was used to identify the cut-off value for the number of surgical experiences necessary to become proficient with LHD, which was defined as the completion of the learning curve.

Results

We defined the completion of the learning curve when the following 3 conditions were satisfied. 1) The operation time was less than 165 minutes. 2) There was no blood loss. 3) There was no intraoperative complication. In order to establish the appropriate number of surgical experiences required to complete the learning curve, the cut-off value was evaluated by using a ROC curve (AUC 0.717, p < 0.001). Finally, we identified the cut-off value as 16 surgical cases (sensitivity 0.706, specificity 0.646).

Conclusion

Learning curve seems to complete after performing 16 cases.

SUBMITTER: Yano F 

PROVIDER: S-EPMC5501549 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Learning curve for laparoscopic Heller myotomy and Dor fundoplication for achalasia.

Yano Fumiaki F   Omura Nobuo N   Tsuboi Kazuto K   Hoshino Masato M   Yamamoto Seryung S   Akimoto Shunsuke S   Masuda Takahiro T   Kashiwagi Hideyuki H   Yanaga Katsuhiko K  

PloS one 20170707 7


<h4>Purpose</h4>Although laparoscopic Heller myotomy and Dor fundoplication (LHD) is widely performed to address achalasia, little is known about the learning curve for this technique. We assessed the learning curve for performing LHD.<h4>Methods</h4>Of the 514 cases with LHD performed between August 1994 and March 2016, the surgical outcomes of 463 cases were evaluated after excluding 50 cases with reduced port surgery and one case with the simultaneous performance of laparoscopic distal partia  ...[more]

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