Learning curve and robot set-up/operative times in singly docked totally robotic Roux-en-Y Gastric bypass

ntroduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common treatments for morbid obesity. The learning curve for this procedure is 50–75 cases for an independent surgeon, and it is considered the most important factor in decreasing complications and mortality. We present our experience and learning curve with LRYGB for a newly established bariatric center in Poland. Material and methods: A prospectively collected database containing 285 LRYGB procedures performed in the II Department of General Surgery of the Jagiellonian University MC in Krakow between 06.2010 and 03.2019 was retrospectively reviewed. Patients were divided into groups of 30 (G1–G10) in the order of the procedures performed by each surgeon. The study analyzed the course of the operation and patient hospitalization, comparing those groups. Learning curve for the newly created bariatric center was established. Results: Operative time in G1–G3 differed significantly from G4–G10 (P < 0.0001). The stabilization point was the 90th procedure. Perioperative complications were observed in 36 (12.63%) patients. Perioperative complications, intraoperative difficulties and adverse events did not differ importantly among groups. Liberal use of “conversions of the operator” from a surgeon to a senior surgeon provides reasonable safety and prevents complications. Conclusions: The institutional learning process stabilization point for LRYGB in a newly established bariatric center is around the 90th operation. LRYGB can be a safe procedure from the very beginning in newly established bariatric centers. Specific bariatric training with active proctoring by an experienced surgeon in a bariatric centre can improve the laparoscopic gastric bypass outcome during the learning curve.

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The Learning Curve for Robotic Roux-en-Y Gastric Bypass

Robotic Surgery ◽

10.1007/978-3-030-53594-0_60 ◽

2021 ◽

pp. 749-757

Author(s):

Jonathan Douissard ◽

Monika E. Hagen ◽

Nicolas C. Buchs

Keyword(s):

Gastric Bypass ◽

Learning Curve

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Global Benchmark Values for Laparoscopic Roux-en-Y-Gastric Bypass: a Potential New Indicator of the Surgical Learning Curve

Obesity Surgery ◽

10.1007/s11695-020-05030-0 ◽

2020 ◽

Author(s):

Guillaume Giudicelli ◽

Michele Diana ◽

Mickael Chevallay ◽

Benjamin Blaser ◽

Chloé Darbellay ◽

...

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Learning Curve ◽

Operative Time ◽

High Volume ◽

Perioperative Outcomes ◽

Morbidity Rate ◽

Bariatric Surgeon ◽

Senior Surgeon ◽

Surgical Learning

Abstract Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a technically demanding procedure. The learning curve of LRYGB is challenging and potentially associated with increased morbidity. This study evaluates whether a general laparoscopic surgeon can be safely trained in performing LRYGB in a peripheral setting, by comparing perioperative outcomes to global benchmarks and to those of a senior surgeon. Methods All consecutive patients undergoing primary LRYGB between January 2014 and December 2017 were operated on by a senior (A) or a trainee (B) bariatric surgeon and were prospectively included. The main outcome of interest was all-cause morbidity at 90 days. Perioperative outcomes were compared with global benchmarks pooled from 19 international high-volume centers and between surgeons A and B for their first and last 30 procedures. Results The 213 included patients had a mean all-cause morbidity rate at 90 days of 8% (17/213). 95.3% (203/213) of the patients were uneventfully discharged after surgery. Perioperative outcomes of surgeon B were all within the global benchmark cutoffs. Mean operative time for the first 30 procedures was significantly shorter for surgeon A compared with surgeon B, with 108.6 min (± 21.7) and 135.1 min (± 28.1) respectively and decreased significantly for the last 30 procedures to 95 min (± 33.7) and 88.8 min (± 26.9) for surgeons A and B respectively. Conclusion Training of a new bariatric surgeon did not increase morbidity and operative time improved for both surgeons. Perioperative outcomes within global benchmarks suggest that it may be safe to teach bariatric surgery in peripheral setting.

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Impact of Fellowship Training on the Learning Curve for Laparoscopic Gastric Bypass

Obesity Surgery ◽

10.1381/096089204322857555 ◽

2004 ◽

Vol 14 (2) ◽

pp. 197-200 ◽

Cited By ~ 58

Author(s):

David Oliak ◽

Milton Owens ◽

Hans J. Schmidt

Keyword(s):

Gastric Bypass ◽

Learning Curve ◽

Laparoscopic Gastric Bypass ◽

Fellowship Training

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Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity: Results of our Learning Curve in 100 Consecutive Patients

Obesity Surgery ◽

10.1381/096089204322857564 ◽

2004 ◽

Vol 14 (2) ◽

pp. 201-205 ◽

Cited By ~ 19

Author(s):

Enrique Stoopen-Margain ◽

Rafael Fajardo ◽

Nayví España ◽

Rosa Gamino ◽

Jorge González-Barranco ◽

...

Keyword(s):

Morbid Obesity ◽

Gastric Bypass ◽

Learning Curve

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Learning curve for laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomosis

Surgical Endoscopy ◽

10.1007/s00464-004-9035-2 ◽

2005 ◽

Vol 19 (4) ◽

pp. 519-524 ◽

Cited By ~ 30

Author(s):

C. Ballesta-Lopez ◽

I. Poves ◽

M. Cabrera ◽

J. A. Almeida ◽

G. Macias

Keyword(s):

Gastric Bypass ◽

Learning Curve

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The value of surgical experience: excess costs associated with the Roux-en-Y gastric bypass learning curve

Surgical Endoscopy ◽

10.1007/s00464-018-6472-x ◽

2018 ◽

Vol 33 (6) ◽

pp. 1944-1951 ◽

Cited By ~ 2

Author(s):

Aristithes G. Doumouras ◽

Fady Saleh ◽

Scott Gmora ◽

Mehran Anvari ◽

Dennis Hong

Keyword(s):

Gastric Bypass ◽

Learning Curve ◽

Surgical Experience ◽

Excess Costs

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Decoding the learning curve of non-descent vaginal hysterectomy in the era of laparoscopy- experience at a Zonal Hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211530 ◽

2021 ◽

Vol 10 (5) ◽

pp. 2015

Author(s):

Shikha Sharma ◽

Jafar Husain ◽

Anshul Jain ◽

Sruthi Bhaskaran ◽

Raj Singh ◽

...

Keyword(s):

Learning Curve ◽

Vaginal Hysterectomy ◽

Limited Resource ◽

Laparoscopic Hysterectomy ◽

Military Hospital ◽

Vaginal Route ◽

Program Objective ◽

Group 2 ◽

Set Up ◽

Group 1

Background: Despite of the increasing popularity of laparoscopic hysterectomy, vaginal route still stays pertinent. Non descent vaginal hysterectomy (NDVH) involves d steep learning curve and hence, should be a fundamental part of every Gynaecology residency program. Objective of the study was to assess the learning curve of NDVH surgery skill at a Military Zonal Hospital by a single Specialist over a period of two years.Methods: Retrospective study conducted at Military Hospital, Agra between June 2015 to June 2017 on 30 patients who underwent NDVH for benign gynaecological conditions.Results: The average blood loss was noted to reduce from a mean of 285ml (±108.94) in the first 20 cases (Group 1) to 227ml (±110.89) in the next 10 cases (Group 2) despite of the average uterine size increasing from 8.5 (±1.43) weeks in Group 1 to 10.2 (±2.39) weeks in Group 2. The average time taken in minutes was also seen to reduce from 89.75 (±12.62) in Group 1 to 70.5 (±16.50) in Group 2 indicating an improvement of surgical skills. The average 24 hr post-operative haemoglobin fall of 0.8gm% was similar between the two groups.Conclusions: Acquiring NDVH skills is a slow but rewarding process. NDVH involves no incisions, no elaborate set-up, avoids complications of general anaesthesia and pneumo-peritoneum and displays similar results as of laparoscopy. In limited resource countries vaginal route may be the only available minimally invasive option for hysterectomy. Hence, it’s pertinent that Gynecologists are trained in the same.

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