• Hugh Mackenzie, Danilo Miskovic, Melody Ni, Amjad Parvaiz, Austin G Acheson, John T Jenkins, John Griffith, Mark G Coleman, and George B Hanna.
• Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM, St Mary's Hospital, Praed St, London, W2 1NY, UK. h.mackenzie@imperial.ac.uk
• Surg Endosc. 2013 Aug 1;27(8):2704-11.

BackgroundThe self-taught learning curve in laparoscopic colorectal surgery (LCS) is between 100 and 150 cases. Supervised training has been shown to shorten the proficiency gain curve of senior specialist surgeons. Little is known about the learning curve of LCS trainees undergoing mentored training. The aim of this study was to analyze the proficiency gain curve and clinical outcomes of English surgical trainees during laparoscopic colorectal surgery fellowships.MethodsIn 2010 the educational, Web-based platform from the National Training Program in Laparoscopic Colorectal Surgery in England was newly available to surgical trainees undertaking a laparoscopic colorectal fellowship. These fellows were asked to submit clinical outcomes, including patient demographics and case specifications. In addition, self-perceived performance was evaluated using a validated task-specific self-assessment form [global assessment scale (GAS) range 1-6]. Proficiency gain curves and learning rates were evaluated using risk-adjusted (RA) cumulative sum (CUSUM) curves.ResultsOf 654 cases 608 were included for analysis. The clinical outcomes included 9.2 % conversions, 16.9 % complications, 4 % reoperations, 2.6 % readmissions and a 0.8 % in-hospital mortality rate. RA CUSUM curves for complications and reoperation do not show a learning effect. However, the RA CUSUM curve for conversion has an inflection point at 24 cases. The GAS CUSUM curves for 'setup' and 'exposure' have inflection points at case 15 and case 29 respectively. The curves for 'mobilization of colon,' 'vascular pedicle' and 'anastomosis' plateau towards the end of the training period. 'Flexure' and 'mesorectum' do not of reach a plateau by case 40.ConclusionsSupervised fellowships provide training in LCS without compromising patient safety. Forty cases are required for the fellows to feel confident to perform the majority of tasks except dissection of the mesorectum and flexure, which will require further training.

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