[Learning curve--calculation and value in laparoscopic surgery].

Abstract

The learning curve shows the progress in mastering a new method. It is completed when the monitored parameters reach a steady state and when the final results can be compared with literature. The earlier used analysis of the performance-improvement with its "on the spots" appraisals at certain time-intervals is replaced by a continuous assessment. The multimode learning curve is particularly useful for it, because not only one parameter (f.e. operation-time), but also several important factors can be put together into one single graphic. For the operation-time, the Moving Average Method is useful. For incidents, which may happen or not like a conversion from laparoscopy to laparotomy as well as complications, the Cusum-method is of practical use. The learning curves of the technique of laparoscopic cholecystectomy, colo-rectal surgery, fundoplicatio and hernia surgery have been completed. Also, the learning curve of the industry is well advanced. Reliable data for the learning curves of individual surgeons for certain operations cannot be given, as, only now, young doctors are being trained on a large scale in laparoscopic technique as used to be the case in the open abdominal surgery. This will influence greatly the learning curves and will shorten the time till their completion. Different bias concerning the individual surgeons and their clinics prohibit the production of comparable curves. Several factors like the patient respectively his abdomen are complicating all this. That's why the learning curves cannot be used as benchmarks to compare different surgeons or clinics, as long as no valid scoring system concerning the complexity of a surgical intervention exists. Learning curves which become quality curves after reaching a steady state, can be used for the individual monitoring of a surgeon's performance and serve as a quality measurement of a clinic. The learning curves of the laparoscopic cholecystectomy, fundoplicatio, colo-rectal surgery and hernia surgery are discussed in particular The mandatory number of operations needed to learn a new method cannot yet be established today, even if all the existing data are consulted. Therefore, the learning curve is a useful instrument to monitor the individual progress and the results of a clinic in the meaning of an individual quality-management. After completion of the learning curve, a quality curve using the same parameters will be given, which shows the deviations of its own standard.