{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T01:04:31Z","timestamp":1783991071665,"version":"3.55.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":55,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100012352","name":"Universit\u00e0 degli Studi di Milano","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012352","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Colorectal Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transanal hemorrhoidal dearterialization (THD) with Anolift mucopexy is a validated non-excisional procedure for hemorrhoidal disease. Although surgeon experience is acknowledged as a determinant of THD outcomes, no formal learning curve analysis exists. This study aimed to characterize the learning curve of a single surgeon adopting THD-Anolift.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective analysis of 60 consecutive THD-Anolift cases (May 2023\u2013February 2026). Nine patients with incomplete outcome data were excluded, leaving 51 for analysis. Median follow-up was 12\u00a0months (range 3\u201333). Cumulative sum (CUSUM) charts were constructed for a composite failure endpoint (recurrence and\/or any complication) and for operative time. The proficiency point was identified at the CUSUM inflection. Sensitivity analyses included CUSUM on recurrence alone, CUSUM restricted to recurrence and Clavien-Dindo\u2009\u2265\u2009II complications, best-case\/worst-case imputation for excluded patients, and risk-adjusted CUSUM controlling for hemorrhoid grade and previous procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median age was 53\u00a0years; 72.5% were male; 80.4% had grade III hemorrhoids. The overall composite failure rate was 37.3% (19\/51) and the recurrence rate 15.7% (8\/51). Mean operative time was 23.5\u2009\u00b1\u20097.4\u00a0min. The composite outcome CUSUM identified a proficiency point at case 23: the failure rate decreased from 52.2% in Phase 1 (cases 1\u201323) to 25.0% in Phase 2 (cases 24\u201351;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.080, not statistically significant at the conventional threshold). Operative time decreased from 27.1\u2009\u00b1\u20097.4 to 20.4\u2009\u00b1\u20096.0\u00a0min (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). On sensitivity analysis, both the recurrence-only CUSUM and the risk-adjusted CUSUM confirmed an identical proficiency point at case 23, and worst-case\/best-case imputation for excluded patients moved the inflection only to cases 25 and 22 respectively, indicating that the finding was robust to endpoint definition and case-mix variation, as well as to plausible patterns of missing data.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CUSUM analysis identified an inflection at approximately 23 cases, with a statistically significant reduction in operative time and a clinically relevant but underpowered reduction in composite failure that did not reach the conventional threshold for statistical significance. Rather than a fixed competency threshold, these findings provide an initial benchmark to help structure supervised adoption\u2014suggesting that the 10 mentored cases conventionally proposed in industry-sponsored teaching may be insufficient\u2014 and to inform future multicenter validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00384-026-05151-5","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T14:34:29Z","timestamp":1779287669000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Defining proficiency in THD-Anolift: a CUSUM analysis of the learning curve in 51 consecutive cases"],"prefix":"10.1007","volume":"41","author":[{"given":"Andrea Cesare","family":"Galli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianlorenzo","family":"Dionigi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Lauricella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Agradi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Sassun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo Emanuele","family":"Leone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Cirocchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Brucchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"5151_CR1","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1002\/bjs.1800810707","volume":"81","author":"PB Loder","year":"1994","unstructured":"Loder PB, Kamm MA, Nicholls RJ, Phillips RK (1994) Haemorrhoids: pathology, pathophysiology and aetiology. 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