166. A STUDY OF THE LEARNING CURVE FOR LAPAROSCOPIC-ASSISTED SINGLE-PORT MEDIASTINOSCOPIC ESOPHAGECTOMY

Abstract Laparoscopic-assisted single-port mediastinoscopic esophagectomy is a safe and effective emerging minimally invasive esophagectomy. However, nothing has been reported about the learning curve for this technique. The goal of this study was to analyze the learning curve of this technique and to determine the number of procedures performed to achieve different levels of proficiency to improve surgeons’ understanding of the learning process of this new technique. This study retrospectively collected clinical data on consecutive laparoscopic-assisted single-port mediastinoscopic esophagectomies performed by the same surgeon at our center from October 2016 to August 2021. A simple scatter plot of the number of procedures versus procedure time and its trend line were plotted, using procedure time as an indicator of efficiency. Learning curves were quantitatively assessed by unadjusted cumulative sum values using the cumulative summation method, different segments were derived using joint point linear regression analysis, and variables were compared between subgroups using trend analysis. The survival analysis was performed using the Kaplan–Meier method. The learning curve could be divided into 3 different stages: the 1st–91st, 91st-125th, and 125th-182nd procedures comprised the preliminary, transition, and proficient stages, respectively. Compared with the preliminary stage, the procedure time, bleeding volume, postoperative hospital stays, and the incidence of anastomotic fistula were significantly lower in the proficiency stage, whereas the number of harvested lymph nodes and the rate of recurrent laryngeal nerve lymph node harvest was significantly higher. Additionally, there were no significant differences in overall survival and disease-free survival at different stages for patients with all, different T stages, and different N stages within 1 year postoperatively. In this study, there may be 3 stages of varying proficiency in the learning curve of laparoscopic-assisted single-port mediastinoscopic esophagectomy. Approximately 91 consecutive procedures were required to overcome the preliminary stage, whereas proficiency in this technique required approximately 125 consecutive procedures. Moreover, as the learning curve reached the proficiency stage, the perioperative indicators tended to stabilize. Furthermore, the short-term survival of patients might not be influenced by technical proficiency.