Determining the learning curve of minimally invasive antireflux surgery: systematic review, meta-analysis, and meta-regression

Sivakumar, J; Chen, Q; Bull, N; Hii, MW; Al-Habbal, Y; Duong, CP

Author(s): Sivakumar, J; Chen, Q; Bull, N; Hii, MW; Al-Habbal, Y; Duong, CP;
Details: Publication Year 2024-11-28,Volume 37,Issue #12,Page 1-13
Journal Title: Diseases of the Esophagus
Publication Type: Review
Abstract: The rapid uptake of minimally invasive antireflux surgery has led to interest in learning curves for this procedure. This study ascertains the learning curve in laparoscopic and robotic-assisted antireflux surgery. A systematic review of the literature pertaining to learning curves in minimally invasive fundoplication with or without hiatal hernia repair was performed using PubMed, Medline, Embase, Web of Science, and Cochrane Library databases. A meta-regression analysis was undertaken to identify the number of cases to achieve surgical proficiency, and a meta-analysis was performed to compare outcomes between cases that were undertaken during a surgeon's learning phase and experienced phase. Twenty-five studies met the eligibility criteria. A meta-regression analysis was performed to quantitatively investigate the trend of number of cases required to achieve surgical proficiency from 1996 to present day. Using a mixed-effects negative binomial regression model, the predicted learning curve for laparoscopic and robotic-assisted antireflux surgery was found to be 24.7 and 31.1 cases, respectively. The meta-analysis determined that surgeons in their learning phase may experience a moderately increased rate of conversion to open procedure (odds ratio [OR] 2.44, 95% confidence interval [CI] 1.28, 4.64), as well as a slightly increased rate of intraoperative complications (OR 1.60; 95% CI 1.08, 2.38), postoperative complications (OR 1.98; 95% CI 1.36, 2.87), and needing reintervention (OR 1.64; 95% CI 1.16, 2.34). This study provides an insight into the expected caseload to be competent in performing antireflux surgery. The discrepancy between outcomes during and after the learning curve for antireflux surgery suggests a need for close proctorship for learning surgeons.
Publisher: Oxford University Press
Keywords: Humans; *Learning Curve; *Fundoplication/methods/education; *Gastroesophageal Reflux/surgery; *Laparoscopy/education/methods/statistics & numerical data; *Robotic Surgical Procedures/education/statistics & numerical data/methods; Clinical Competence; Hernia, Hiatal/surgery; Female; Male; Conversion to Open Surgery/statistics & numerical data; Regression Analysis; Middle Aged; Postoperative Complications/etiology/epidemiology; Adult; fundoplication; hiatal hernia; surgical education
Department(s): Surgical Oncology
Publisher's Version: https://doi.org/10.1093/dote/doae073
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-12-19 06:00:44

Last Modified: 2024-12-19 06:01:06