Learning curve of surgical novices using the single-port platform SymphonX: minimizing OR trauma to only one 15-mm incision

Abstract Background Minimally invasive single-port surgery is always associated with large incisions up to 2–3 cm, complicated handling due to the lack of triangulation, and instrument crossing. The aim of this prospective study was to report how medical students without any laparoscopic experience perform several laparoscopic tasks (rope pass, paper cut, peg transfer, recapping, and needle threading) with the new SymphonX single-port platform and to examine the learning curves in comparison to the laparoscopic multi-port technique. Methods A set of 5 laparoscopic skill tests (Rope Pass, Paper cut, Peg Transfer, Recapping, Needle Thread) were performed with 3 repetitions. Medical students performed all tests with both standard laparoscopic instruments and the new platform. Time and errors were recorded. Results A total of 114 medical students (61 females) with a median age of 23 years completed the study. All subjects were able to perform the skill tests with both standard laparoscopic multi-port and the single-port laparoscopic system and were able to significantly improve their performance over the three trials for all five tasks—rope pass (p < 0.001), paper cut (p < 0.001), peg transfer (p < 0.001), needle threading (p < 0.001), and recapping (p < 0.001). In 3 out of 5 tasks, medical students performed the tasks faster using the standard multi-port system—rope pass (p < 0.001), paper cut (p < 0.001), and peg transfer (p < 0.001). In the task recapping, medical students performed the task faster using the new single-port system (p = 0.003). In the task needle threading, there was no significant difference between the standard multi-port system and the new single-port system (p > 0.05). Conclusion This is the first study analyzing learning curves of the commercially available SymphonX platform for abdominal laparoscopic surgery when used by novices. The learning curve and the error rate are promising.

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Single-Incision Laparoscopic Cholecystectomy: A Combined Analysis of Resident and Attending Learning Curves at a Single Institution

The American Surgeon ◽

10.1177/000313481207800148 ◽

2012 ◽

Vol 78 (1) ◽

pp. 119-124

Author(s):

Mark Joseph ◽

Michael Phillips ◽

Christopher C. Rupp

Keyword(s):

Laparoscopic Cholecystectomy ◽

Learning Curve ◽

Single Incision ◽

Learning Curves ◽

Patient Specific ◽

Short Learning Curve ◽

Significant Difference ◽

Surgeon Experience ◽

Standard Laparoscopic Cholecystectomy ◽

Single Incision Laparoscopic Cholecystectomy

Single-incision laparoscopic cholecystectomy (SILC) is a recent technical modification on standard laparoscopic cholecystectomy that has been shown to be safe and feasible. Recent studies suggest that experienced laparoscopic surgeons have a short learning curve to become proficient in SILC. However, little is known about the interaction of the learning curves of residents and attending surgeons at academic programs. We prospectively evaluated various metrics of both attending and resident surgeons as they progressed in their experience with SILC. Patients were placed into cohorts of 25 based on teaching surgeon experience. Data recorded included patient-specific and operative variables along with complications, conversion to standard laparoscopic cholecystectomy, and outcomes. One hundred one patients underwent SILC. Twelve per cent of patients required conversion to standard laparoscopic cholecystectomy. No significant difference was found in operative times compared within the experience-based cohorts ( P = 0.21). A reduction in operative time was shown in residents who were proficient in standard laparoscopic cholecystectomy (SLC) along their learning curve. Operative times remained the same for the teaching surgeon regardless of experience of resident surgeon. SILC has a short learning curve for resident surgeons who are proficient in standard laparoscopic surgery. SILC can be effectively taught with few complications and outcomes similar to SLC with preservation of operative efficiency and safety. Further studies are warranted, however, at a national/international level to define the place and use for SILC as well as the incorporation of single-incision techniques into resident curriculum.

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Investigating the learning curve in endoscopic compared to microscopic myringotomy and ventilation tube insertion

The Journal of Laryngology & Otology ◽

10.1017/s0022215120001188 ◽

2020 ◽

Vol 134 (6) ◽

pp. 497-500

Author(s):

O Denton ◽

A Daglish ◽

L Smallman ◽

S Fishpool

Keyword(s):

Learning Curve ◽

Learning Curves ◽

Learning Rate ◽

Middle Ear Surgery ◽

Ventilation Tube ◽

Ear Surgery ◽

Steep Learning Curve ◽

Learning Rates ◽

Significant Difference ◽

Rate Of Learning

AbstractObjectiveRate of learning is often cited as a deterrent in the use of endoscopic ear surgery. This study investigated the learning curves of novice surgeons performing simulated ear surgery using either an endoscope or a microscope.MethodsA prospective multi-site clinical research study was conducted. Seventy-two medical students were randomly allocated to the endoscope or microscope group, and performed 10 myringotomy and ventilation tube insertions. Trial times were used to produce learning curves. From these, slope (learning rate) and asymptote (optimal proficiency) were ascertained.ResultsThere was no significant difference between the learning curves (p = 0.41). The learning rate value was 68.62 for the microscope group and 78.71 for the endoscope group. The optimal proficiency (seconds) was 32.83 for the microscope group and 27.87 for the endoscope group.ConclusionThe absence of a significant difference shows that the learning rates of each technique are statistically indistinguishable. This suggests that surgeons are not justified when citing ‘steep learning curve’ in arguments against the use of endoscopes in middle-ear surgery.

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Single-Port Access Laparoscopy-Assisted Vaginal Hysterectomy: Our Initial Experiences with 100 Cases

Minimally Invasive Surgery ◽

10.1155/2012/543627 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Young-Sam Choi ◽

Kwang-Sik Shin ◽

Jin Choi ◽

Ji-No Park ◽

Yun-Sang Oh ◽

...

Keyword(s):

Vaginal Hysterectomy ◽

Single Port ◽

Bladder Injury ◽

Safe Procedure ◽

Single Port Access ◽

Laparoscopically Assisted Vaginal Hysterectomy ◽

Single Port Surgery ◽

Port Access ◽

Pelvic Hematoma ◽

Port System

Objectives.To present our initial experiences with laparoscopically assisted vaginal hysterectomy performed using homemade transumbilical single-port system.Materials and Methods.We reviewed the medical records of one hundred patients who underwent single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH). SPA-LAVH was performed with homemade single port system and conventional rigid laparoscopic instruments.Results.All procedures were successfully completed through the single-port system and vagina without need for extraumbilical puncture or conversion to laparotomy. The median patient age was 48.2 ± 6.5 years. Thirty-three patients had history of past abdominopelvic surgery. The median total operative time, largest dimension of the uterus, and weight of the uterus were 73.1 ± 24.6 min, 10.5 ± 2.1 cm, and 300.8 ± 192.5 gram, respectively. The median decline in the hemoglobin from before surgery to postoperative day 1 was 1.8 ± 0.9 g/dL. Bladder injury in occurred one patient who was repaired through intraoperative laparoscopic suture. The postoperative course was uneventful in most patients except for three who had a transient paralytic ileus, five who had pelvic hematoma, but they were recovered following conservative managements. No port-related complications were noted, and the cosmetic results were excellent.Conclusions.SPA-LAVH is technically safe procedure, and the homemade single-port system offers reliable access for single-port surgery.

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Moving Forward from the “Boot Camp Method” To Learning-Curve Development in Simulation-Based Paracentesis Training For Undergraduate Medical Students

10.21203/rs.3.rs-276089/v1 ◽

2021 ◽

Author(s):

Martin Inzunza ◽

Rodrigo Tejos ◽

Ignacio Villagrán ◽

Eduardo Fuentes ◽

Caterina Contreras ◽

...

Keyword(s):

Medical Students ◽

Learning Curve ◽

Boot Camp ◽

Learning Curves ◽

Control Group ◽

Skills Acquisition ◽

Undergraduate Medical Students ◽

Skills Retention ◽

Skill Scores ◽

Simulation Based

Abstract Background: Abdominal paracentesis is an essential competence for physicians. Simulation-based mastery learning (SBML) programs lead to developing these skills for medical students. Most programs are structured as short boot-camps, without assessing skills' retention mid and long-term or learning curves.Aim: To assess the learning curve of paracentesis through an SBML program for medical students and compare this learning curve-based program with the boot-camp method.Methods: A prospective quasi-experimental study was conducted. A cohort of medical students participated in an SBML program with successive sessions until proficiency criteria were met while their learning curve was assessed (LC group). A control group received an SBML boot-camp intervention (BC group). As a proficient group, gastroenterology fellows (GF group) performed a paracentesis on the simulated model. The skills of the three groups were compared using technical/proficiency scores. Learning curves and cost analysis were performed.Results: 100% of the LC group achieved proficiency in the fourth session, with a flattening learning curve between third-fourth sessions. Comparing the initial and final sessions of LC group showed a significant improvement in their scores. When comparing the three groups, statistical differences were found in the skill scores, with the BC group having the lowest. The overall cost per participant was highest for the LC group.Conclusion: This study identifies a learning curve for paracentesis with an SBML program. The LC group significantly improved their skills, comparable with the GF group’s performance. SBML focused on a learning curve ensured better skills acquisition than the “boot-camp method.”

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Must Clinics Replace 2D by 3D Environments for an Efficient Training of Laparoscopic Novices? A Critical Analysis of the Learning Curve for Basic Skills

Frontiers in Surgery ◽

10.3389/fsurg.2021.792107 ◽

2022 ◽

Vol 8 ◽

Author(s):

Maik Sahm ◽

Clara Danzer ◽

Alexis Leonhard Grimm ◽

Christian Herrmann ◽

Rene Mantke

Keyword(s):

Laparoscopic Surgery ◽

Learning Curve ◽

Repeated Measures ◽

Linear Mixed Model ◽

Standardized Test ◽

Operation Time ◽

Error Rates ◽

Learning Curves ◽

Significant Difference ◽

2D And 3D

Background and AimsPublished studies repeatedly demonstrate an advantage of three-dimensional (3D) laparoscopic surgery over two-dimensional (2D) systems but with quite heterogeneous results. This raises the question whether clinics must replace 2D technologies to ensure effective training of future surgeons.MethodsWe recruited 45 students with no experience in laparoscopic surgery and comparable characteristics in terms of vision and frequency of video game usage. The students were randomly allocated to 3D (n = 23) or 2D (n = 22) groups and performed 10 runs of a laparoscopic “peg transfer” task in the Luebeck Toolbox. A repeated-measures ANOVA for operation times and a generalized linear mixed model for error rates were calculated. The main effects of laparoscopic condition and run, as well as the interaction term between the two, were examined.ResultsNo statistically significant differences in operation times and error rates were observed between 2D and 3D groups (p = 0.10 and p = 0.72, respectively). The learning curve showed a significant reduction in operation time and error rates (both p's < 0.001). No significant interactions between group and run were detected (operation time: p = 0.342, error rates: p = 0.83). With respect to both endpoints studied, the learning curves reached their plateau at the 7th run.ConclusionThe result of our study with laparoscopic novices revealed no significant difference between 2D and 3D technology with respect to performance time and the error rate in a simple standardized test. In the future, surgeons may thus still be trained in both techniques.

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Comparison of second and third generation total ankle arthroplasty learning curves

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00181 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0018

Author(s):

Ryan Callahan ◽

Michael Aynardi ◽

Kempland Walley ◽

Kaitlin Saloky ◽

Paul Juliano

Keyword(s):

Learning Curve ◽

Learning Curves ◽

Total Ankle Arthroplasty ◽

Complication Rates ◽

Fixed Bearing ◽

Ankle Arthroplasty ◽

2Nd Generation ◽

Significant Difference ◽

Surgeon Experience ◽

Reoperation Rates

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has evolved over the past decades with later generation implants being associated with improved instrumentation and hardware. There have been multiple reports of the “learning curve” associated with total ankle arthroplasty. These report higher complication rates during the initial procedures performed by an inexperienced surgeon. To our knowledge, there is no comparison of the 2nd generation and 3 rd generation implant learning curves. Methods: The clinical outcomes of the first 15 cases (8/2002-4/2005) of a 2nd generation fixed bearing prosthesis (Agility Total Ankle System) and the first 15 cases (6/2007-3/2009) of a 3 rd generation fixed bearing prosthesis (Salto Talaris® TotalAnkle Prosthesis) performed by a single surgeon were retrospectively reviewed to determine complication incidence. The initial cases with each system were also independently reviewed to determine if there was a significant learning curve in regards to complications. Reoperation, infection, gutter impingement, fracture, persistent pain, and periprosthetic cyst formation were included for comparison of complication rates. Results: The overall complication rates for the Agility were 54.9% (28/51) and 35.7% (25/70) for Salto Talaris. There was no significant difference in reoperation rates when comparing the first 15 Agility cases (8/15, 53%) to the remainder of Agility cases (11/36, 30.6%) p=0.2. The initial 15 Salto Talaris cases also demonstrated no significant difference in reoperation rates (1/15, 8%) when compared to the remaining Salto Talaris replacements (7/55, 12.7%) p=1. Reoperation rates were higher in the initial 15 Agility cases (8/15, 53%) compared to the initial 15 Salto cases (1/15, 8%) p=0.01. There was no significant difference in infection, hardware failure, and medial malleolus fracture rates for any of the groups. Conclusion: While this series demonstrated no significant learning curve for each individual total ankle system, there was a significantly higher reoperation rate in the initial cases for the 2nd generation TAA when compared to the initial cases of the 3 rd generation implants. This could be attributed to improved instrumentation and hardware and/or surgeon experience.

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A Prospective Assessment of Knee Arthroscopy Skills Between Medical Students and Residents—Simulator Exercises for Partial Meniscectomy and Analysis of Learning Curves

Surgical Innovation ◽

10.1177/15533506211037792 ◽

2021 ◽

pp. 155335062110377

Author(s):

David Putzer ◽

Dietmar Dammerer ◽

Martina Baldauf ◽

Florian Lenze ◽

Michael C. Liebensteiner ◽

...

Keyword(s):

Medical Students ◽

Learning Curve ◽

Knee Arthroscopy ◽

Learning Curves ◽

Cartilage Tissue ◽

Mean Values ◽

Training Tool ◽

Hand Eye Coordination ◽

Prospective Assessment ◽

Task Assessment

Background The Covid-19 pandemic has created the largest disruption of education in history. In a response to this, we aimed to evaluate the knee arthroscopy learning curve among medical students and orthopaedic residents. Methods An arthroscopy simulator was used to compare the learning curves of two groups. Medical students with any prior knowledge of arthroscopy ( n=24) were compared to a residents group ( n=16). Analyzed parameters were “time to complete a task,” assessment of the movement of tools and values scoring damage to the surrounding tissues. Results After several repetitions, both groups improved their skills in terms of time and movement. Residents were on average faster, had less camera movement, and touched the cartilage tissue less often than did students. Students showed a steeper improvement curve than residents for certain parameters, as they started from a different experience level. Conclusion The participants were able to reduce the time to complete a task. There was also a decrease in possible damage to the virtual surrounding tissues. In general, the residents had better mean values, but the students had the steeper learning curve. Particularly less experienced surgeons can especially train their hand–eye coordination skills required for arthroscopy surgery. Training simulators are an important training tool that supplements cadaveric training and participation in arthroscopic operations and should be included in training.

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Laparoscopic Pyloromyotomy: A Study of the Learning Curve

European Journal of Pediatric Surgery ◽

10.1055/s-0037-1603090 ◽

2017 ◽

Vol 28 (03) ◽

pp. 238-242 ◽

Cited By ~ 1

Author(s):

François Bastard ◽

Pierre Meignan ◽

Karim Braïk ◽

Anne Le Touze ◽

Thierry Villemagne ◽

...

Keyword(s):

Postoperative Complications ◽

Learning Curve ◽

Operative Time ◽

Hospital Length ◽

Learning Curves ◽

Hospital Length Of Stay ◽

Minimally Invasive Surgical ◽

Significant Difference ◽

Laparoscopic Pyloromyotomy

Introduction Laparoscopic pyloromyotomy (LPM) is a minimally invasive surgical technique used in pyloric stenosis treatment. This technique is safe, effective, and does not show more complications than laparotomy. Nevertheless, this technique requires an acquisition period to be optimally applied. This study analyses the learning curve of LPM. Materials and Methods Seven surgeons were retrospectively evaluated on their 40 first LPM. Patient data were recorded, including peroperative data (operation length and complications) and postoperative recoveries (renutrition, vomiting, and complications). The learning curves were evaluated and each variable was compared with the different moments of the learning curve. Results The mean operative time is 25 ± 11 minutes. It significantly decreases with the learning curve (p < 0.01). Ten procedures were necessary to acquire the operative technics. However, postoperative complications with a necessary redo procedure appear after the 10th patient. There is no significant difference concerning long-term postoperative complications according to the learning curve and to surgeons. The best results are recorded after the 20th patients. Hospital length of stay also decreases significantly after the 10th procedure. The recorded postoperative vomiting is independent to the operative time as the ad libitum feedings recovery. Conclusion The learning curve of LPM is cut into three stages. Only 10 cases are needed to acquire the gesture. Complications appear after this acquirement period.

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Learning Curve Associated With an Automated Laparoscopic Suturing Device Compared With Laparoscopic Suturing

Surgical Innovation ◽

10.1177/1553350616687903 ◽

2017 ◽

Vol 24 (2) ◽

pp. 109-114 ◽

Cited By ~ 2

Author(s):

Steven G. Leeds ◽

Lizzy Wooley ◽

Ganesh Sankaranarayanan ◽

Yahya Daoud ◽

James Fleshman ◽

...

Keyword(s):

Learning Curve ◽

Learning Curves ◽

Laparoscopic Technique ◽

Task Completion ◽

Crossing Over ◽

Knot Tying ◽

Laparoscopic Suturing ◽

Lower Accuracy ◽

Significant Difference ◽

Laparoscopic Techniques

Background. Laparoscopic suturing has proved to be a challenging skill to master which may prevent surgical procedures from being started, or completed, in a minimally invasive fashion. The aim of this study is to compare the learning curves between traditional laparoscopic techniques with a novel suturing device. Methods. In this prospective single blinded nonrandomized controlled crossover study, we recruited 19 general surgery residents ranging from beginner (PGY1-2, n = 12) to advanced beginner (PGY3-5, n = 7). They were assigned to perform a knot tying and suturing task using either Endo360 or traditional laparoscopic technique (TLT) with needle holders before crossing over to the other method. The proficiency standards were developed by collecting the data for task completion time (TCT in seconds), dots on target (DoT in numbers), and total deviation (D in mm) on 5 expert attending surgeons (mean ± 2SD). The test subjects were “proficient” when they reached these standards 2 consecutive times. Results. Number of attempts to complete the task was collected for Endo360 and TLT. A significant difference was observed between mean number of attempts to reach proficiency for Endo360 versus TLT ( P = .0027) in both groups combined, but this was not statistically significant in the advanced beginner group. TCT was examined for both methods and demonstrated significantly less time to complete the task for Endo360 versus TLT ( P < .0001). There were significantly less DoT for Endo360 as compared with TLT ( P < .0001), which was also associated with significantly less D ( P < .0001) indicating lower accuracy with Endo360. However, no significant difference was observed between the groups for increasing number of trials for both DoT and D. Conclusions. This novel suturing device showed a shorter learning curve with regard to number of attempts to complete a task for the beginner group in our study, but matched the learning curve in the advanced beginner group. With regard to time to complete the task, the device was faster in both groups.

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Learning Curve for Laparoscopic Repair of Pediatric Inguinal Hernia Using Percutaneous Internal Ring Suturing

Children ◽

10.3390/children8040294 ◽

2021 ◽

Vol 8 (4) ◽

pp. 294

Author(s):

Zenon Pogorelić ◽

Dario Huskić ◽

Tin Čohadžić ◽

Miro Jukić ◽

Tomislav Šušnjar

Keyword(s):

Inguinal Hernia ◽

Laparoscopic Surgery ◽

Postoperative Complications ◽

Hernia Repair ◽

Learning Curve ◽

Operative Time ◽

Learning Curves ◽

The Other ◽

Internal Ring ◽

Significant Difference

Background: Percutaneous internal ring suturing (PIRS) is a simple and popular technique for the treatment of inguinal hernia in children. The aim of this study was to analyze the learning curves during implementation of PIRS in our department. Methods: A total of 318 pediatric patients underwent hernia repair using the PIRS technique by three pediatric surgeons with different levels of experience in laparoscopic surgery. These patients were enrolled in a prospective cohort study during the period October 2015–January 2021. Surgical times, intraoperative and postoperative complications, in addition to outcomes of treatment were compared among the pediatric surgeons. Results: Regarding operative time a significant difference among the surgeons was found. Operative time significantly decreased after 25–30 procedures per surgeon. The surgeon with advanced experience in laparoscopic surgery had significantly less operative times for both unilateral (12 (interquartile range, IQR 10.5, 16.5) min vs. 21 (IQR 16.5, 28) min and 25 (IQR 21.5, 30) min; p = 0.002) and bilateral (19 (IQR 14, 21) min vs. 28 (IQR 25, 33) min and 31 (IQR 24, 36) min; p = 0.0001) hernia repair, compared to the other two surgeons. Perioperative complications, conversion, and ipsilateral recurrence rates were higher at the beginning, reaching the benchmarks when each surgeon performed at least 30 PIRS procedures. The most experienced surgeon had the lowest number of complications (1.4%) and needed a fewer number of cases to reach the plateau. The other two surgeons with less experience in laparoscopic surgery had higher rates of complications (4.4% and 5.4%) and needed a higher number of cases to reach the plateau (p = 0.190). Conclusions: A PIRS learning curve for perioperative and postoperative complications, recurrences, and conversion rates reached the plateau after each surgeon had performed at least 30 cases. After that number of cases PIRS is a safe and effective approach for pediatric hernia repair. A surgeon with an advanced level of experience in pediatric laparoscopic surgery adopted the technique more easily and had a significantly faster learning curve.

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