ArticlePediatric surgery international2026
A study of the learning curve for laparoscopic Nissen fundoplication procedure, focusing on operative times using cumulative sum (CUSUM) method and multiple regression analysis for patients with neuromuscular disease.
Article in Pediatric surgery international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
purposeThe number of cases necessary to achieve proficiency in laparoscopic Nissen fundoplication (Lap-Nissen) remains unclear. We analyzed operative times using the cumulative sum (CUSUM) method to construct learning curves and estimate the required case volume.
methodsWe retrospectively reviewed patients who underwent Lap-Nissen at our institution beginning in October 2008. Learning curves for each surgeon were constructed using CUSUM analysis and divided into three phases (I-III) by piecewise linear regression.
resultsA total of 109 cases were analyzed. For surgeon A (n = 46), the mean operative time decreased across phases I (cases 1-8, 299.4 min), II (9-32, 217.7 min), and III (33-46, 179.6 min). Similar trends were observed for surgeon B (n = 42): I (1-5, 328.2 min), II (6-30, 204.4 min), and III (31-42, 179.5 min). Surgeon C (n = 14) delivered no clear learning curve, and surgeons D-F were excluded due to low case numbers. Multiple regression analysis identified the surgeons' experience as the strongest factor associated with operative time (β = - 0.53, p < 0.001).
conclusionPhase I comprised approximately five cases, while phase II included more than 30 cases. Larger multicenter prospective studies are warranted.
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