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

ABSTRACT Objective: To describe the learning curve that shows the progress of a single neurosurgeon when performing single-level MI-TLIF. Methods: We included 99 consecutive patients who underwent single-level MI-TLIF by the same neurosurgeon (JASS). Patient’s demographic characteristics were analyzed. In addition, surgical time, intraoperative blood loss and hospital stay were evaluated. The learning curves were calculated with a piecewise regression model. Results: The mean age was 54.6 years. The learning curves showed an inverse relationship between the surgical experience and the variable analyzed, reaching an inflection point for surgical time in case 43 and for blood loss in case 48. The mean surgical time was 203.3 minutes (interquartile range [IQR] 150-240 minutes), intraoperative bleeding was 97.4ml (IQR 40-100ml) and hospital stay of four days (IQR 3-5 days). Conclusions: MI-TLIF is a very frequent surgical procedure due to its effectiveness and safety, which has shown similar results to open procedure. According to this study, the required learning curve is slightly higher than for open procedures, and is reached after about 45 cases.

Download Full-text

Learning curve for laparoscopic Roux-en-Y gastric bypass based on the experience of a newly created bariatric center

Polish Journal of Surgery ◽

10.5604/01.3001.0014.1513 ◽

2020 ◽

Vol 92 (4) ◽

pp. 23-30

Author(s):

Jadwiga Dworak ◽

Michał Wysocki ◽

Anna Rzepa ◽

Michał Pędziwiatr ◽

Dorota Radkowiak ◽

...

Keyword(s):

Morbid Obesity ◽

Gastric Bypass ◽

Adverse Events ◽

Learning Curve ◽

Operative Time ◽

Perioperative Complications ◽

Safe Procedure ◽

Experienced Surgeon ◽

Institutional Learning ◽

Complications And Mortality

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.

Download Full-text

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

Surgical Endoscopy ◽

10.1007/s00464-013-3362-0 ◽

2014 ◽

Vol 28 (5) ◽

pp. 1629-1633 ◽

Cited By ~ 13

Author(s):

Subhashini Ayloo ◽

Eduardo Fernandes ◽

Nabajit Choudhury

Keyword(s):

Gastric Bypass ◽

Learning Curve ◽

Set Up

Download Full-text

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

Download Full-text

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.

Download Full-text