Decision-making and technical factors account for the learning curve in complex surgery
Open Access
- 26 July 2006
- journal article
- research article
- Published by Oxford University Press (OUP)
- Vol. 28 (4), 375-378
- https://doi.org/10.1093/pubmed/fdl048
Abstract
Introduction The general public, the legal profession, patients and relatives expect best practice and have difficulty with the concept of a learning curve in surgical interventions. However, it is improbable that technical and innovative skills can be developed, or optimized, without some aspects of learning by experience and indeed ‘risk taking’. Patients and Method A single surgeon experience with a novel, complex, surgical procedure for peritoneal malignancy is described and compared with recent literature reports on the surgical learning curve. In total, 100 of 242 (41%) patients referred underwent a laparotomy. The 100 were divided into three numerically equal groups of 33, 33 and 34 cases, and the proportions undergoing surgery, mortality and major morbidity rates for the three groups were analysed. Results The numbers undergoing surgery were 33/54 (61%), 33/96 (34%) and 34/92 (37%). The mortality was 6/33 (18%), 1/33 (3%) and 1/33 (3%), and the major morbidity rates were 9/33 (27%), 2/33 (6%) and 0/34 (0%) in the three groups. Conclusions The main components of the learning curve were considered to be decision-making and technical factors. A mechanism to reduce the surgical learning curve is suggested involving teamwork, and at least two experienced surgeons involved in all major surgical interventions. Decision-making and technical factors account for the learning curve in complex surgery.Keywords
This publication has 15 references indexed in Scilit:
- Long-term Survival Following Treatment of Pseudomyxoma PeritoneiAnnals of Surgery, 2005
- The learning curveBMJ, 2004
- Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy With Mitomycin C for Peritoneal Carcinomatosis from Nonappendiceal Colorectal CarcinomaAnnals of Surgical Oncology, 2004
- Toxicity of cytoreductive surgery and hyperthermic intra‐peritoneal chemotherapyJournal of Surgical Oncology, 2004
- Intraperitoneal Chemohyperthermia Using a Closed Abdominal Procedure and Cytoreductive Surgery for the Treatment of Peritoneal Carcinomatosis: Morbidity and Mortality Analysis of 216 Consecutive ProceduresAnnals of Surgical Oncology, 2003
- The etiology, clinical presentation, and management of pseudomyxoma peritoneiSurgical Oncology Clinics of North America, 2003
- Cytoreductive surgery and peri-operative intraperitoneal chemotherapy as a curative approach to pseudomyxoma peritonei syndromeEuropean Journal of Surgical Oncology, 2001
- Morbidity and Mortality Analysis of 200 Treatments With Cytoreductive Surgery and Hyperthermic Intraoperative Intraperitoneal Chemotherapy Using the Coliseum TechniqueAnnals of Surgical Oncology, 1999
- A Learning Curve for Laparoscopic FundoplicationAnnals of Surgery, 1996
- Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapyCancer, 1996