ArticleSurgical endoscopy2023
CUSUM learning curves: what they can and can't tell us.
Article in Surgical endoscopy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
50 citing papers in PubMed, 2 syntheses or guidelines pooled it, 72 citations in OpenAlex.
- Long-term efficacy and learning curves of Cohen and modified Glenn-Anderson pneumovesicoscopic ureteral reimplantation for primary obstructive megaureter: a retrospective cohort study with meta-analysis.Pediatric surgery international · 2026Pooled it
- Learning curve for lateral lymph node dissection in rectal cancer - a systematic review of literature.Techniques in coloproctology · 2025Pooled it
- Shape-sensing robotic-assisted bronchoscopy (ss-RAB) for peripheral pulmonary nodules: learning curve and diagnostic performance from an initial multicenter experience in China.Respiratory research · 2026Trial
- Determining the learning curve for anterolateral supine total hip arthroplasty: a retrospective analysis of six hundred and forty consecutive cases performed by a single surgeon.International orthopaedics · 2026Article
- Multimodal analysis of the learning curve for pure laparoscopic donor right hepatectomy in a low-volume transplant center: a comparative cohort study.Surgical endoscopy · 2026Article
- Limitations of procedural learning curves: reassessment of the clinical relevance of learning curve analysis in robotic right hemicolectomy.Journal of robotic surgery · 2026Article
- Learning curve-associated safety in minimally invasive esophagectomy using a time-based supervisory takeover strategy: a propensity score-weighted analysis of 603 VATS procedures.Surgical endoscopy · 2026Article
- Learning curves in Versius-assisted colorectal surgery: a risk-adjusted CUSUM analysis from a single center.International journal of colorectal disease · 2026Article
- Robotic cholecystectomy during surgical training: learning curve and perioperative outcomes of 441 consecutive cases in a high-volume teaching center.Journal of robotic surgery · 2026Article
- Laparoscopic vs. robotic cholecystectomy for patients with cirrhosis: A propensity score-matched, single center analysis.Journal of robotic surgery · 2026Article
- Initial adaptation to robotic rectal cancer surgery using the hinotori surgical robot system: a CUSUM analysis of certified proctor surgeons.Journal of robotic surgery · 2026Article
- How many cases to proficiency? A systematic review of the learning curve in endoscopic lumbar interbody fusion.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Review
- Perioperative Outcomes of Robotic Versus Conventional Total Laparoscopic Hysterectomy in Surgically Complex Cases: A Propensity Score-Matched Study.Journal of clinical medicine · 2026Article
- Designing self-assessment tools for learning five instrumental clinical procedures in ENT: A modified Delphi consensus approach.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2026Article
- Learning curve analysis across three surgical eras in Ivor Lewis esophagectomy.Journal of robotic surgery · 2026Article
- Training in lung ultrasound for the diagnosis of lower respiratory tract infections in children under five years of age in rural healthcare facilities in Guatemala.Journal of global health · 2026Observational
- Learning curve of single-port robot-assisted simple prostatectomy: a risk-adjusted CUSUM analysis.Journal of robotic surgery · 2026Article
- Learning curves, safety, and experiences of a tertiary surgical center in the introduction of robotic-assisted surgery in gynecologic oncology.Archives of gynecology and obstetrics · 2026Article
- Operative time-based learning curve and surgical outcomes of laparoscopic radical prostatectomy in a surgeon with limited open surgery experience.BMC surgery · 2026Article
- Learning Curve of Da Vinci Xi Robotic Low Anterior Resection: A Cumulative Sum Analysis of a Single High-Volume Surgeon.Journal of clinical medicine · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThere has been increased interest in assessing the surgeon learning curve for new skill acquisition. While there is no consensus around the best methodology, one of the most frequently used learning curve assessments in the surgical literature is the cumulative sum curve (CUSUM) of operative time. To demonstrate the limitations of this methodology, we assessed the CUSUM of console time across cohorts of surgeons with differing case acquisition rates while varying the total number of cases used to calculate the CUSUM.
methodsWe compared the CUSUM curves of the average console times of surgeons who completed their first 20 robotic-assisted (RAS) cases in 13, 26, 39, and 52 weeks, respectively, for their first 50 and 100 cases, respectively. This analysis was performed for prostatectomy (1094 surgeons), malignant hysterectomy (737 surgeons), and inguinal hernia (1486 surgeons).
resultsIn all procedures, the CUSUM curve of the cohort of surgeons who completed their first 20 procedures in 13 weeks demonstrated a lower slope than cohorts of surgeons with slower case acquisition rates. The case number at which the peak of the CUSUM curve occurs uniformly increases when the total number of cases used in generation of the CUSUM chart changes from 50 to 100 cases.
conclusionThe CUSUM analyses of these three procedures suggests that surgeons with fast initial case acquisition rates have less variability in their operative times over the course of their learning curve. The peak of the CUSUM curve, which is often used in surgical learning curve literature to denote "proficiency" is predictably influenced by the total number of procedures evaluated, suggesting that defining the peak as the point at which a surgeon has overcome the learning curve is subject to routine bias. The CUSUM peak, by itself, is an insufficient measure of "conquering the learning curve."
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.