The outcome of laparoscopic pancreatoduodenectomy is improved with patient selection and the learning curve

Laparoscopic pancreatoduodenectomy is a challenge for the surgeon due to its technical difficulty. The learning curve is long and difficult. Objective. To show the joint experience of two surgeons in more than 100 laparoscopic pancreatoduodenectomy. Material and methods. We analysed all patients treated by laparoscopic pancreatoduodenectomy by two specialist surgeons in the period between May 2012 and May 2018. Inclusion criteria: patients with periampullary disease with indication of pancreatoduodenectomy. Exclusion criteria: patients with evident vascular compromise by images, metastatic disease or bad performance status. Results. Laparoscopic pancreatoduodenectomy was performed in 108 patients; 61 surgeries were totally laparoscopic, 35 were hybrid surgeries, and 12 were converted to open surgery. There was a significant decrease in operative time from case number 30. Twelve surgeries (11.3%) were converted. Pancreatic fistula occurred in 35 of 108 patients (32.4%). Twenty-six patients presented pancreatic fistula type A (24.1%), and 9 (8.3%) fistula B/C. The B/C fistula rate was 8.2% in laparoscopic pancreatic anastomosis, 8.6% in those reconstructed by mini-laparotomy and 8.3% in the converted patients. Reoperation was required (Dindo-Clavien 3) in 19 patients (17.5%). Mortality was 4.6% (5 patients), 2 within 30 days and 3 within 90 days. The median total hospital stay was 8.5 days (range: 4-83). Conclusion. Laparoscopic pancreatoduodenectomy is a viable and reproducible procedure that should be applied in selected cases during the learning curve, increasing its application as the number of operations carried out increases.

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Lessons learned during implementation of MR-guided High-Intensity Focused Ultrasound treatment of uterine fibroids

Insights into Imaging ◽

10.1186/s13244-021-01128-w ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

K. J. Anneveldt ◽

I. M. Verpalen ◽

I. M. Nijholt ◽

J. R. Dijkstra ◽

R. D. van den Hoed ◽

...

Keyword(s):

Learning Curve ◽

Patient Selection ◽

High Intensity ◽

Focused Ultrasound ◽

Uterine Fibroids ◽

Lessons Learned ◽

High Intensity Focused Ultrasound ◽

Patient Counseling ◽

Hifu Treatment ◽

Medical Specialists

Abstract Background Although promising results have been reported for Magnetic Resonance image-guided High-Intensity Focused Ultrasound (MR-HIFU) treatment of uterine fibroids, this treatment is not yet widely implemented in clinical practice. During the implementation of a new technology, lessons are learned and an institutional learning-curve often has to be completed. The primary aim of our prospective cohort study was to characterize our learning-curve based on our clinical outcomes. Secondary aims included identifying our lessons learned during implementation of MR-HIFU on a technical, patient selection, patient counseling, medical specialists and organizational level. Results Our first seventy patients showed significant symptom reduction and improvement of quality of life at 3, 6 and 12 months after MR-HIFU treatment compared to baseline. After the first 25 cases, a clear plateau phase was reached in terms of failed treatments. The median non-perfused volume percentage of these first 25 treatments was 44.6% (range: 0–99.7), compared to a median of 74.7% (range: 0–120.6) for the subsequent treatments. Conclusions Our findings describe the learning-curve during the implementation of MR-HIFU and include straightforward suggestions to shorten learning-curves for future users. Moreover, the lessons we learned on technique, patient selection, patient counseling, medical specialists and organization, together with the provided supplements, may be of benefit to other institutions aiming to implement MR-HIFU treatment of uterine fibroids. Trial registration ISRCTN14634593. Registered January 12, 2021—Retrospectively registered, https://www.isrctn.com/ISRCTN14634593.

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329 Patient selection and learning curve influence the results of transapical aortic valve implantation

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(10)70331-1 ◽

2010 ◽

Vol 2 (1) ◽

pp. 108

Author(s):

Patrick Nataf ◽

Nawwar Al-Attar ◽

Costin Radu ◽

Dominique Himbert ◽

Richard Raffoul ◽

...

Keyword(s):

Aortic Valve ◽

Learning Curve ◽

Patient Selection ◽

Aortic Valve Implantation ◽

Valve Implantation

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Robot-Assisted Cystectomy: Getting Started: Prior Experience, Learning Curve, and Initial Patient Selection

Robotic Surgery of the Bladder ◽

10.1007/978-1-4614-4906-5_3 ◽

2013 ◽

pp. 27-35

Author(s):

Matthew K. Tollefson ◽

Mitchell R. Humphreys

Keyword(s):

Learning Curve ◽

Patient Selection ◽

Prior Experience ◽

Robot Assisted

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Biphasic learning curve of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy:technical competence and refinement of patient selection

Pleura and Peritoneum ◽

10.1515/pp-2018-0122 ◽

2018 ◽

Vol 3 (4) ◽

Cited By ~ 3

Author(s):

Nicholas B Shannon ◽

Grace Hwei Ching Tan ◽

Claramae Shulyn Chia ◽

Khee Chee Soo ◽

Melissa Ching Ching Teo

Keyword(s):

Learning Curve ◽

Hospital Stay ◽

Patient Selection ◽

Cytoreductive Surgery ◽

Peritoneal Metastasis ◽

Operation Time ◽

Secondary Outcome ◽

Complication Rates ◽

Severe Morbidity ◽

Duration Of Surgery

AbstractBackgroundCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is routinely used for selected patients with peritoneal metastasis, but can be associated with high complication rates, prolonged hospital stay, and mortality. Our objective was to determine the learning curve of CRS/HIPEC in our institution, representing the largest Asian cohort to date.MethodsA total of 200 consecutive patients with peritoneal metastasis treated with CRS/HIPEC between 2001 and 2016 were grouped into four cohorts of 50 patients and studied. Primary outcomes were severe morbidity (Clavien-Dindo III-V), procedure-related mortality, and duration of ICU and hospital stays. Secondary outcome was duration of surgery.ResultsMedian age was 53 years (10–75). There was no significant age, sex, or histology difference across cohorts. Rates of severe morbidity (23 %), and 60 day inpatient mortality (0.5 %) were comparable to previously reported data. Decreases in rates of serious morbidity, (34 %, 30 %, 12 %, 14 %, p<0.01) and duration of total hospital stay (14, 16, 13, 12 days, p=0.041) were seen across consecutive cohorts. Operation time decreased significantly after the first cohort (10, 7.8, 7.8, 7.2 h, p<0.01), despite increase in average PCI score after the first cohort (8, 14, 12, 13, p=0.063).ConclusionsWhilst 50 cases were adequate for procedural familiarity and decreased average operation time, significant improvement in rate of serious morbidity was observed after 100 operations. We demonstrate a novel biphasic nature to the learning curve, reflecting initial training in which technical competence is achieved, followed by a subsequent period characterized by increasingly complex cases (higher PCI score) and finally refinement of patient selection.

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