ArticleTechniques in coloproctology2018
The effect of proctoring on the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms.
Article in Techniques in coloproctology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 25 citations in OpenAlex.
- Single-port robotic versus laparoscopic transanal minimally invasive surgery (TAMIS) for rectal neoplasms: a first comparative analysis of surgical efficiency and clinical outcomes.Surgical endoscopy · 2026Article
- Learning curve of transanal minimally invasive surgery for rectal neoplasm.Frontiers in oncology · 2025Article
- Effect of virtual reality training to enhance laparoscopic assistance skills.BMC medical education · 2024Article
- Transanal Endoscopic Platforms: TAMIS versus Rigid Platforms: Pros and Cons.Clinics in colon and rectal surgery · 2022Review
- Transanal Endoscopic Surgery: Who Should Be Doing This Procedure?Clinics in colon and rectal surgery · 2022Review
- Education and Training in Transanal Endoscopic Surgery and Transanal Total Mesorectal Excision.Clinics in colon and rectal surgery · 2021Review
- Novel box trainer for taTME - prospective evaluation among medical students.Innovative surgical sciences · 2019Article
- TAMIS is a valuable alternative to TEM for resection of intraluminal rectal tumors.Techniques in coloproctology · 2019Article
- Transanal minimally invasive surgery - A single-center experience.Journal of minimal access surgeryArticle
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe current method of choice for local resection of benign and selected malignant rectal tumors is transanal endoscopic microsurgery. Transanal minimally invasive surgery (TAMIS) yields similar oncological results and better patient reported outcomes when compared to transanal endoscopic micro surgery. However, due to the technical complexity of TAMIS, a significant learning curve has been suggested. Data on the surgical learning curve are limited. The aim of our study was to investigate surgeon specific learning curves for TAMIS procedures for the local excision of selected rectal tumors, and analyze the effects of proctoring on operating time and outcome.
methodsThe current study was prospective of all TAMIS procedures performed by two surgeons from October 2010 to November 2017. Margin positivity, specimen fragmentation, adverse events and operative time were evaluated with a cumulative sum analysis to determine the number of procedures required to reach proficiency. Cumulative sum (CUSUM) analysis was used to determine trends in changes over time.
resultsThe earliest adopter, surgeon A, performed 103 procedures, was not proctored and developed the standardized institutional program. Surgeon B, performed 26 cases, had the benefit of a proctorship and availability of a standardized program. The CUSUM curve for operative time showed a change after 36 cases for surgeon A and after 10 cases for surgeon B. For margin positivity proficiency was reached after 31 and 6 cases for surgeon A and B, respectively. The complications curve for surgeon A showed a three-phase learning curve with a decrease after the 26th case whereas surgeon B only had one (3.8%) complication in the learning phase with no change point in the CUSUM curve. Comparing pre- and post-proficiency periods there was a decrease in operating time for both surgeon A (84.4 ± 47.3 to 55.9 ± 30.1 min) and surgeon B (90.6 ± 64.to 53 ± 26.5 min; p < 0.001). Overall margin positivity rates decreased non significantly from 21.7 to 4.8% (p = 0.23). Complications were higher in the pre-proficiency period (21.7% vs. 13.0%; p = 0.02). Surgeon A had significantly more postoperative complications in pre-proficiency phase when compared to surgeon B (25% vs. none, p < 0.001), in the post-proficiency phase there was no statistically significant difference between both surgeons (p = 0.08).
conclusionsOur results suggest that to reach satisfactory results for TAMIS, 18-31 procedures are required. Standardized institutional operative protocols together with proficient proctorship may contribute to a shorter learning curve with fewer cases (6-10) required to reach proficiency.
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