Overcoming the Arduous Transition for Robotic Hepatopancreatobiliary Cases: A Multi-Procedure Learning Curve Study Utilizing CUSUM Analysis

2020 ◽  
Author(s):  
Joseph S. Lim ◽  
Terence Jackson ◽  
James Kurtz ◽  
Edward E. Cho ◽  
Shyam Vedantam ◽  
...  
Keyword(s):  
Learning Curve ◽  
Cusum Analysis ◽  
Procedure Learning

Learning curve for robot-assisted Ivor Lewis esophagectomy

2021 ◽  
Author(s):  
Yu Han ◽  
Yajie Zhang ◽  
Wentian Zhang ◽  
Jie Xiang ◽  
Kai Chen ◽  
...  
Keyword(s):  
Learning Curve ◽  
Complication Rate ◽  
Major Complication ◽  
Robot Assisted ◽  
Ivor Lewis ◽  
Initial Learning ◽  
Cusum Analysis ◽  
Technical Proficiency ◽  
Major Complication Rate ◽  
Two Phases

Summary This study aimed to demonstrate the learning curve of robot-assisted minimally invasive esophagectomy (RAMIE). A retrospective analysis of the first 124 consecutive patients who underwent RAMIE with intrathoracic anastomosis (Ivor Lewis) by a single surgeon between May 2015 and August 2020 was performed. An risk-adjusted cumulative sum (RA-CUSUM) analysis was applied to generate a learning curve of RAMIE considering the major complication rate, which reflected the technical proficiency. The overall 30-day morbidity rate was 38.7%, while the major complication rate was 25.8%. The learning curve was divided into two phases based on the RA-CUSUM analysis: phase I, the initial learning phase (cases 1–51) and phase II, the proficiency phase (cases 52–124). As we compared the proficiency phase with the initial learning phase, significantly decreased trends were observed in relation to the major complication rate (37.3% vs. 18.7%, P = 0.017), total operation time (330.9 ± 55.6 vs. 267.3 ± 39.1 minutes, P < 0.001), and length of hospitalization (10 [IQR, 9–14] days vs. 9 [IQR, 8–11] days, P = 0.034). In conclusion, the learning curve of RAMIE consisted of two phases, and at least 51 cases were required to gain technical proficiency.

scholarly journals TCT-737 MONITORING THE LEARNING CURVE AND QUALITY OF CARE IN TAVI PROCEDURES BY CUSUM ANALYSIS

2013 ◽  
Vol 62 (18) ◽  
pp. B224-B225 ◽  
Author(s):  
Alfredo Giuseppe Cerillo ◽  
Michele Murzi ◽  
Massimiliano Mariani ◽  
Federica Marchi ◽  
Stefano Maffei ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Learning Curve ◽  
Cusum Analysis

Incorporating New Technology Into a Surgical Technique: The Learning Curve of a Single Surgeon's Stereo-Electroencephalography Experience

Neurosurgery ◽  
2019 ◽  
Vol 86 (3) ◽  
pp. E281-E289 ◽  
Author(s):  
Robert A McGovern ◽  
Robert S Butler ◽  
James Bena ◽  
Jorge Gonzalez-Martinez
Keyword(s):  
Surgical Technique ◽  
Learning Curve ◽  
Clinical Experience ◽  
Imaging Modality ◽  
Imaging Techniques ◽  
New Technology ◽  
Surgical Techniques ◽  
Vascular Imaging ◽  
New Paradigm ◽  
Cusum Analysis

Abstract BACKGROUND Technological improvements frequently outpace the publication of randomized, controlled trials in surgical patients. This makes the application of new surgical techniques difficult as surgeons solely use clinical experience to guide changes in their practice. OBJECTIVE To quantitatively examine the learning curve of incorporating new technology into a surgical technique and discuss the clinical significance of incorporating this new technology into daily practice. To identify areas of improvement for operative efficiency and safety. METHODS A retrospective observational study examining quantitative measures of operative efficiency and safety from 2009 to 2017 in 454 consecutive patients undergoing stereo-electroencephalography depth electrode implantations. RESULTS The transition to a new robotic technique significantly improved operative times (196 min [95% CI 173-219] vs 115 min [95% CI 111-118], P < .0001). Cumulative sum (CUSUM) analysis demonstrated that mastery of the robotic technique took much longer than the frame-based technique (operative time peak at case 75 vs case 25, plateau of 150 vs 10 cases). Although hemorrhage rates using different vascular imaging techniques did not appear to differ using traditional statistical analysis (magnetic resonance imaging, MRI 22.3%, computed tomography angiography, CTA 17.9%, angiogram 18.1%, likelihood ratio χ2 = 4.84, P = .30), CUSUM analysis suggested MRI as the vascular imaging modality leading to higher hemorrhage and symptomatic hemorrhage rates at our center. CONCLUSION This experience demonstrates an improvement in operative efficiency through a series of changes made using clinical experience and intuition while transitioning to a completely new paradigm. CUSUM analysis identified potential areas for improvement in both operative efficiency and safety if used in a prospective manner.

Surgical margins and biochemical recurrence risk at 2 years for robotic prostatectomy: Comprehensive evaluation and CUSUM analysis of oncological outcomes.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 80-80
Author(s):  
Arjun Sivaraman ◽  
Rafael Sanchez-Salas ◽  
Dominic Prapotnich ◽  
Kaixin Yu ◽  
Fabien Olivier ◽  
...  
Keyword(s):  
Learning Curve ◽  
Biochemical Recurrence ◽  
Transition Point ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Oncological Outcomes ◽  
Cusum Analysis

80 Background: To evaluate the learning curve of Minimally Invasive Radical Prostatectomy (MIRP) in our institution and apply the cumulative summation (CUSUM) analytical technique to identify salient learning curve transition points in terms of oncological outcomes. Methods: Clinical, pathologic, and oncological outcome data were collected from our prospectively collected MIRP database to estimate Positive Surgical margin (PSM) and Biochemical Recurrence (BCR) trends during a 15 year period from 1998 to 2013. All the RPs (laparoscopic (LRP) / Robotic Assisted [RARP]) were performed by 9 surgeons. PSM was defined as presence of cancer cells at inked margins. BCR was defined as serum Prostate Specific Antigen (PSA) >0.2 ng/ml and rising or start of secondary therapy. Surgical learning curve was assessed with the application of Kaplan-Meier curves, Cox regression model, CUSUM and logistic model in order to define the “transition point” of surgical improvement. Results: We identified 5,547 patients with localized prostate cancer treated with MIRP (3,846 - LRP and 1,701 – RARP). Patient characteristics of LRP and RARP were similar. The overall risk of PSM in LRP was 25%, 20% and 17% for the first 50, 50 to 350 and >350 cases, respectively. For the same population, the 5-year BCR rate decreased from 21.5% to 16.7%. RARP started 3 years after the LRP program (after approximately 250 LRP). The PSM rate for RARP decreased from 21.8% to 20.4% and the corresponding 5-year BCR rate decreased from 17.6% to 7.9%. The CUSUM analysis showed significantly lower PSM and BCR at 2 years occurred at the transition point of 350 cases for LRP and 100 cases for RARP. In multivariable analysis, predictors of BCR were PSA, Gleason score, extra prostatic disease, seminal vesicle invasion and number of operations (p < 0.05). Patients harboring PSM showed higher BCR risk (23% vs. 8%, p < 0.05). Conclusions: Learning curve trends of MIRP in our large, single center experience showed significant reduction in PSM and BCR risk at 2 years are noted after the initial 350 cases and 100 cases of LRP and RARP, respectively.

scholarly journals Learning curve for gasless endoscopic thyroidectomy using the trans-axillary approach: CUSUM analysis of a single surgeon's experience

2014 ◽  
Vol 12 (12) ◽  
pp. 1273-1277 ◽  
Author(s):  
Hee Yong Kwak ◽  
Sang Hoon Kim ◽  
Byung Joo Chae ◽  
Byung Joo Song ◽  
Sang Seol Jung ◽  
...  
Keyword(s):  
Learning Curve ◽  
Endoscopic Thyroidectomy ◽  
Axillary Approach ◽  
Cusum Analysis

Determining the Learning Curve of Transcutaneous Laryngeal Ultrasound in Vocal Cord Assessment by CUSUM Analysis of Eight Surgical Residents: When to Abandon Laryngoscopy

2015 ◽  
Vol 40 (3) ◽  
pp. 659-664 ◽  
Author(s):  
Kai-Pun Wong ◽  
Brian Hung-Hin Lang ◽  
Shi Lam ◽  
Kin-Pan AU ◽  
Diane Toi-yin Chan ◽  
...  
Keyword(s):  
Learning Curve ◽  
Vocal Cord ◽  
Surgical Residents ◽  
Cusum Analysis

scholarly journals The learning curve for ultrasound-guided peripheral intravenous cannulation in adults: a multicenter study

2022 ◽  
Author(s):  
Fredericus HJ Van Loon ◽  
Harm J Scholten ◽  
Hendrikus HM Korsten ◽  
Angelique TM Dierick - van Daele ◽  
Arthur RA Bouwman
Keyword(s):  
Learning Curve ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Training Session ◽  
Hands On ◽  
Individual Participant ◽  
Cusum Analysis ◽  
Multicenter Prospective Observational Study ◽  
Two Phases ◽  
Cannulation Success

Aims: To lower the threshold for applying ultrasound (US) guidance during peripheral intravenous cannulation, nurses need to be trained and gain experience in using this technique. The primary outcome was to quantify the number of procedures novices require to perform before competency in US-guided peripheral intravenous cannulation was achieved. Materials and methods: A multicenter prospective observational study, divided into two phases after a theoretical training session: a hands-on training session and a supervised life-case training session. The number of US-guided peripheral intravenous cannulations a participant needed to perform in the life-case setting to become competent was the outcome of interest. Cusum analysis was used to determine the learning curve of each individual participant. Results: Forty-nine practitioners participated and performed 1855 procedures. First attempt cannulation success was 73% during the first procedure, but increased to 98% on the fortieth attempt (p<0.001). The overall first attempt success rate during this study was 93%. The cusum learning curve for each practitioner showed that a mean number of 34 procedures was required to achieve competency. Time needed to perform a procedure successfully decreased when more experience was achieved by the practitioner, from 14±3 minutes on first proce-dure to 3±1 minutes during the fortieth procedure (p<0.001). Conclusions: Competency in US-guided peripheral intravenous cannulation can be gained after following a fixed educational curriculum, resulting in an increased first attempt cannulation success as the number of performed procedures increased.

scholarly journals Learning curve of patient specific templates for TKA. Assessment with a navigation system and the CUSUM test.

10.29007/dqtx ◽  
2018 ◽  
Author(s):  
Jean-Yves Jenny ◽  
Marco De Gori
Keyword(s):  
Steady State ◽  
Learning Curve ◽  
Navigation System ◽  
Academic Department ◽  
Patient Specific ◽  
Cusum Test ◽  
Cusum Analysis

The CUSUM analysis allows monitoring the learning curve when introducing PSTs for TKA in an academic department. There may be a significant learning curve to achieve the steady state of accuracy and obtain an acceptable alignment. The decision was taken to discontinue using PSTs for TKA..

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