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Learning Curve for Laparoscopic Sleeve Gastrectomy: a Cumulative Summation (CUSUM) Analysis

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Abstract

Purpose

Bariatric surgery is currently considered the most effective and durable treatment option for morbid obesity. Laparoscopic sleeve gastrectomy (LSG) has become a popular technique and may currently be the most frequently practiced surgical operation to treat obesity. However, no objective analyses of its learning curve have been reported. Objective: to analyze the learning curve for LSG.

Materials and Methods

We included all LSGs performed in our hospital (University Hospital, Spain; Public Practice) from April 2013 to February 2016. The learning curve for LSG was evaluated using cumulative sum (CUSUM) analysis. All variables among the learning curve phases were compared.

Results

According to the CUSUM analysis, the learning curve was divided into three unique phases: early learning (the initial 26 patients), acquisition of skills (the middle 30 patients), and mastery of technique (the final 56 patients). The operative time and gastric stenosis significantly decreased with progression of the learning curve without differences in the 30-day postoperative complication rate, postoperative stay, or weight loss.

Conclusion

According to this study, the learning curve for LSG can be divided into 3 distinct phases, and about 25 patients are needed to demonstrate an improvement in surgical skill.

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Authors and Affiliations

  1. General Surgery Service, “Virgen de La Arrixaca” Clinical University Hospital, 30120, El Palmar, Murcia, Spain

    Pedro J. Gil, Juan José Ruiz-Manzanera, David Ferreras, Víctor López & Pablo Ramírez

  2. Bariatric Surgery Unit and Upper Gastrointestinal Surgical, General Surgery Service, “Virgen de La Arrixaca” Clinical University Hospital, 30120, El Palmar, Murcia, Spain

    David Ruiz de Angulo

  3. General Surgery Service, Upper Gastrointestinal Surgical Unit, “Virgen de La Arrixaca” Clinical University Hospital, 30120, El Palmar, Murcia, Spain

    Vicente Munitiz, Ana Conesa, Ángeles Ortiz & Luisa F. Martínez de Haro

  4. Instituto Murciano De Investigación Biosanitaria (IMIB), 30120, El Palmar, Murcia, Spain

    Pablo Ramírez

Authors
  1. Pedro J. Gil
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  2. Juan José Ruiz-Manzanera
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  3. David Ruiz de Angulo
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  4. Vicente Munitiz
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  5. David Ferreras
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  6. Víctor López
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  7. Ana Conesa
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  8. Ángeles Ortiz
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  9. Luisa F. Martínez de Haro
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  10. Pablo Ramírez
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Corresponding author

Correspondence to Juan José Ruiz-Manzanera.

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All of the procedures carried out in studies with human participants were in accordance with the ethical standards of the institutional and/or national research committee and the Declaration of Helsinki of 1964 and its subsequent modifications or comparable ethical standards.

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The authors declare no competing interests.

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Key Points.

• CUSUM analysis is useful for objective evaluation of the laparoscopic sleeve gastrectomy (LSG) learning curve with respect to identifying areas for improvement.

• LSG is a safe and efficient bariatric procedure, even early in the learning curve.

• The learning curve can be divided into three distinct phases, and about 25 patients are needed to demonstrate an improvement in skills.

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Gil, P.J., Ruiz-Manzanera, J.J., Ruiz de Angulo, D. et al. Learning Curve for Laparoscopic Sleeve Gastrectomy: a Cumulative Summation (CUSUM) Analysis. OBES SURG 32, 2598–2604 (2022). https://doi.org/10.1007/s11695-022-06145-2

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  • DOI: https://doi.org/10.1007/s11695-022-06145-2

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