The Learning Curve Analysis In Laparoscopic-assisted Natural Orifice Specimen Extraction For Radical Sigmoidectomy And Rectectomy Using Cai Tube

Objective To analyze the learning curve in laparoscopic-assisted natural orifice specimen extraction(LA-NOSE)using Cai Tube for 74 cases of radical sigmoidectomy and rectectomy performed by a single-center surgical team.Methods From January 2014 to July 2019,the single-center surgical team had completed LA-NOSE for 74 cases of radical sigmoidectomy and rectectomy using Cai Tube.The clinical data of 74 patients undergoing surgery were retrospectively analyzed.With the operation time as the target,the cumulative summation(CUSUM)and moving average(MA)were applied to analyze the learning curve.The basic data,intraoperative situation,postoperative recovery,postoperative complications,postoperative oncology effect,postoperative anal function score,postoperative visual analog scale and other clinical data of the patients in different phases of the learning curve were compared to assess learning process security.Also,the relationship between different factors and operation time was analyzed.Results The learning curve can be divided into two stages.The first stage of learning curve is 1～31 cases,and the second stage is 32 ～ 74 cases.The operation time was shortened from(246.19±42.29)min in the first stage to(208.28±44.58)min in the second stage(P < 0.05).The comparison results of the two stages show no statistically significant differences in basic data,intraoperative conditions,postoperative recovery,postoperative complications,postoperative oncology effect,postoperative anal function score and postoperative anesthesia pain score.Multiple linear regression analysis showed that Body Mass Index(BMI),maximum tumor transverse diameter and learning curve phase were significantly correlated with the operation time.Conclusion The learning curve of LA-NOSE for radical sigmoidectomy and rectectomy using Cai Tube is smooth and the learning process is safe.The selection of patients with a BMI < 25 kg/m2 and a maximum tumor diameter < 3.0cm for surgery was conducive to faster passage through the first stage of the learning curve.