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Evaluation of the learning curve for laparoscopic pyloromyotomy

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Abstract

Background

Laparoscopic pyloromyotomy is the preferred surgical management of hypertrophic pyloric stenosis at most centers. We aimed to analyze the learning curve for laparoscopic pyloromyotomy using the experience of five fellowship-trained pediatric surgeons.

Methods

A retrospective review of consecutive patients undergoing laparoscopic pyloromyotomy was performed. All cases were performed with general surgery residents. Cumulative sum (CUSUM) analysis for operating time was performed for up to the first 150 consecutive cases for individual surgeons. Outcomes were compared to identify different phases of the learning curve for operative competency.

Results

A total of 414 patients were included in the analysis as not all surgeons had reached 150 cases at time of analysis. The mean operating time was 29.2 min for all cases across the 5 surgeons. CUSUM analysis for mean operating time revealed three phases of learning: Learning Phase (cases 1-16), Plateau Phase (cases 17-87), and a Proficiency Phase (cases 88-150). The mean operating time during the three phases was 34.1, 29.0, and 28.3 min, respectively (P = 0.005). There were no differences in complications, reoperations, length of stay, or readmissions across the three phases.

Conclusion

Three distinct phases of learning for laparoscopic pyloromyotomy were identified with no differences in outcomes across the phases. The operating time differed only for the Learning Phase, suggesting that some degree of proficiency occurs after 16 cases.

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Abbreviations

ACGME:

Accreditation Council for Graduate Medical Education

CUSUM:

Cumulative sum

HPS:

Hypertrophic pyloric stenosis

LP:

Laparoscopic pyloromyotomy

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Funding

Jennifer T. Castle is funded by the NIH Training Grant T32CA160003.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, University of Kentucky and Kentucky Children’s Hospital, 800 Rose Street, MS463A, Lexington, KY, 40536, USA

    Brittany E. Levy, Nicholas Bontrager, Jennifer T. Castle & David J. Worhunsky

  2. Department of General Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Mia MacDonald

  3. Department of Surgery, Nemours Children’s Health, Jacksonville, FL, USA

    John M. Draus Jr

Authors
  1. Brittany E. Levy
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  2. Mia MacDonald
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  3. Nicholas Bontrager
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  4. Jennifer T. Castle
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  6. David J. Worhunsky
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Correspondence to David J. Worhunsky.

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Disclosure

Dr. Brittany Levy is a consultant for Johnson and Johnson. Drs. Jennifer Castle, Mia MacDonald, John Draus, David Worhunsky, and Mr. Nicholas Bontrager have no conflicts of interest or financial ties to disclose.

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Levy, B.E., MacDonald, M., Bontrager, N. et al. Evaluation of the learning curve for laparoscopic pyloromyotomy. Surg Endosc 37, 5101–5108 (2023). https://doi.org/10.1007/s00464-023-09962-3

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  • DOI: https://doi.org/10.1007/s00464-023-09962-3

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