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- Title
Peroral Endoscopic Myotomy; Novice Surgeon Learning Curve.
- Authors
Bach, Gregory H.; Crowell, Winston; Griffith, Jennifer; Rachman, Ben; Bigness, Alec; Reddy, Nikhil; Sujka, Joseph; Mhaskar, Rahul; DuCoin, Christopher
- Abstract
Introduction: Peroral endoscopic myotomy (POEM) is a novel endoscopic procedure used to treat achalasia and other spastic esophageal disorders that is an alternative to Heller myotomy. We seek to define the learning curve of POEM for a foregut surgeon with no formal endoscopic or POEM training by analyzing different intraoperative factors in a single series. Methods and Procedures: The first 38 consecutive patients undergoing POEM by a single foregut surgeon were included in this retrospective study. Inverse curve regression models were used to analyze total operative time (TOT) and total operative time per centimeter of myotomy (TOT-CM), in addition to other intraoperative variables. Clinical outcomes were reported as pre- and post-operative Eckardt Scores. Results: All patients had type II achalasia with no post-operative complications observed. Eckardt scores improved postoperatively (median (range): 1 (0-4)) compared with the preoperative scores (10 (8-12)) (P <.001). The total operative time (median 76 minutes, range 51-129) decreased significantly over the course of the series (R2 =.38, P <.001), with a learning plateau at 70 minutes and a learning rate of 12 cases. Total operative time per centimeter of myotomy (median 7.08 min/cm, range 4.25 to 15.38) decreased over time (R2 =.45, P <.001), with a learning plateau at 7 minutes/cm and a learning rate of 12 cases. Conclusion: The number of cases for a foregut surgeon to become proficient in a POEM procedure was found to be 12-14 cases. The learning curve for a POEM in a formally trained foregut surgeon may be comparable to an endoscopically trained interventionist.
- Subjects
MYOTOMY; SURGEONS; FOREGUT; SURGICAL complications; MINIMALLY invasive procedures
- Publication
American Surgeon, 2023, Vol 89, Issue 11, p4305
- ISSN
0003-1348
- Publication type
Article
- DOI
10.1177/00031348221109457