Fixation Type Does not Affect the Learning Curve and Short-Term Radiographic Outcomes for Arthroscopic Anatomic Glenoid Reconstruction with Distal Tibia Allograft

ABSTRACT BACKGROUND: Endoscopic submucosal dissection (ESD) is a complex endoscopic procedure, with high rates of adverse events and technical difficulties. To overcome that problem, many training centers published the importance of animal models for skill acquirement in ESD. However, no study has used the submucosal dissection depth (DSUB) as a parameter to evaluate the learning curve in ESD, which might be a relevant factor since an optimal resection plane is important to achieve a curative resection and avoid intraoperative complications. OBJECTIVE: This study aimed to assess ESD skill acquirement after short-term training sessions by evaluating the submucosal dissection depth (DSUB) and the association with adverse events. METHODS: This experimental study included 25 experienced endoscopists in therapeuthic procedures (>5years) and 75 specimens resected by ESD (three resections / endoscopist). Learning parameters (resection time, size, en bloc resection rate, bleeding, perforation and submucosal dissection depth) were prospectively evaluated. The percentages of DSUB of all specimens resected were calculated. RESULTS: All specimens were resected from the gastric body (n=75). The mean size of the resected specimens was 23.97±7.2 mm. The number of adverse events, including bleeding, perforation, and death, were 17 (22.67%), 3 (4%), and 0 cases, respectively. The average mean time by the third dissection decreased from 28.44±9.73 to 18.72±8.81 min (P<0.001). The proportion of DSUB in the bleeding and non-bleeding group were respectively 37.97%±21.13% and 68.66%±23.99%, indicating a significant association between DSUB and bleeding incidence (P<0.001). The ROC curve analysis indicated a cut-off point of 61% (sensitivity, 64%; specificity, 94%) of submucosal dissection depth associated with bleeding. Therefore, when ESD was performed at a depth of >61% of the submucosal layer, the risk for bleeding during the procedure decreased (PPV, 0.97; 95% CI, 0.85-0.99). CONCLUSION: Improvement in the learning curve in ESD and a better cognitive ability were seen by the third dissection in these short term training courses. And a significant association between DSUB and the risk of bleeding.

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Short-term and long-term outcomes of robotic, laparoscopic and open radical gastrectomy in gastric cancer: A single-center retrospective study

10.21203/rs.2.15339/v1 ◽

2019 ◽

Author(s):

Weifan Zhang ◽

Xinhui Zhao ◽

Zhao Liu ◽

Hui Dang ◽

Lei Meng ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Learning Curve ◽

Operation Time ◽

Open Gastrectomy ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Estimated Blood Loss

Abstract Background: Few studies on the comparison among robotic, laparoscopic, and open gastrectomy had been reported in gastric cancer . The goal of this study was to evaluate the advantages of robotic-assisted gastrectomy (RAG) by comparing with laparoscopic-assisted gastrectomy(LAG) and open gastrectomy (OG). Methods: 147 gastric cancer patients who underwent gastrectomy were enrolled and retrospectively analyzed between January 2017 and July 2019. Short-term outcomes such as operation time, intraoperative estimated blood loss(EBL),number of retrieved lymph nodes, postoperative recovery, learning curve, and long-term outcome such as overall survival(OS) was compared among RAG, LAG and OG groups. Results: RAG group included 47 patients, 44 in the LAG, and 61 in the OG. Basic information such as gender, age, BMI, ASA degree were similar among three groups, and there were no statistically significances in pathological TNM staging, tumor resection extent, resection margin, methods of reconstruction( P ＞0.05). The cumulative sum(CUSUM) method showed that learning curve of RAG reached stability after 17 cases . For short-term outcomes, the RAG group had the shortest EBL( P =0.033), the shortest time to first flatus( P ＜0.001), shortest time to first intake liquid diet ( P =0.004),shortest postoperative hospital stay ( P =0.023)and the largest number of retrieved lymph nodes( P =0.044),the longest operation time( P ＜0.001), the most expensive treatment cost( P ＜0.001),however, there were no significant differences in postoperative drainage, postoperative white blood cell(WBC)count and early complications among three group( P ＞0.05). In addition to long-term outcome, similar OS was observed in three groups. Conclusion: Compared with LAG and OG, RAG has certain advantages in short-term outcomes and is a safe and reliable surgical method. But still need further prospective, multi-center research to confirm this.

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Learning curve and short-term outcomes of modularized LADG for advanced gastric cancer

Medicine ◽

10.1097/md.0000000000014670 ◽

2019 ◽

Vol 98 (10) ◽

pp. e14670

Author(s):

Gang Liao ◽

Ziwei Wang ◽

Hui Li ◽

Jiang Min ◽

Jinkun Zhong ◽

...

Keyword(s):

Gastric Cancer ◽

Learning Curve ◽

Advanced Gastric Cancer ◽

Short Term

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Short-term Outcomes After Robot-Assisted vs Open Pancreaticoduodenectomy After the Learning Curve

JAMA Surgery ◽

10.1001/jamasurg.2020.0021 ◽

2020 ◽

Vol 155 (5) ◽

pp. 389 ◽

Cited By ~ 6

Author(s):

Yusheng Shi ◽

Jiabin Jin ◽

Weihua Qiu ◽

Yuanchi Weng ◽

Jian Wang ◽

...

Keyword(s):

Learning Curve ◽

Robot Assisted ◽

Short Term ◽

Open Pancreaticoduodenectomy

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Endoscopic vein harvesting Impact of learning curve on results and rehabilitation

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2005.595 ◽

2005 ◽

Vol 64 (2) ◽

Author(s):

Alessandro Piccardo ◽

Luigi Martinelli ◽

Giancarlo Passerone

Keyword(s):

Learning Curve ◽

Left Internal Mammary Artery ◽

Consecutive Series ◽

Short Term ◽

Mean Velocity ◽

Reliable Technique ◽

Endoscopic Vein Harvesting ◽

The Mean ◽

The Impact ◽

Vein Harvesting

Background: The tendency of modern surgery is towards the reduction of invasiveness. The aim of this study is to evaluate the impact of the learning curve, the reliability, the short term results and the advantages in terms of rapid rehabilitation of endoscopic vein harvesting (EVH) in a consecutive series of 20 patients operated on of aorto-coronary bypass surgery. Methods: Between February and June 2005, 20 patients between 61 e 82 years of age underwent EVH with the use of Vasoview® 5 (Guidant Corporation, Indianapolis, USA). To evaluate the impact of learning curve on the total operative time, patients were divided in 4 chronologically consecutive groups (G1, G2, G3, G4). Intraoperative characteristics and short term results were evaluated. Results: The mean velocity and the mean time of harvesting in G4 were 0,68 cm/min and 45 min. respectively, similar to the time required for a scheletonized left internal mammary artery harvesting. In the first 5 patients 2 conversions were required, one of them related to the EVH technique. No bleeding, functional impairment or infective complications are reported. Active mobilization was possible in every case in the first post-operative day. Conclusions: EVH is a reliable technique and the learning curve can be limited to the first 5 cases. The foreseeble reduction of infectious complications, the absence of pain and the immediate mobilization of the leg allow a rapid and effective rehabilitation.

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