Initial learning curve of single-incision transaxillary robotic hemi- and total thyroidectomy – A single team experience from Europe

The aim of this study was to evaluate the learning curve of robotic thyroid surgery with regard to both operation time and temporary hypoparathyroidism using quantitative statistical analysis. A total of 194 patients who underwent total thyroidectomy and concomitant central compartment node dissection for papillary thyroid carcinoma by a single surgeon between December 2008 and September 2017 were enrolled. The learning curve for operation time was assessed using the cumulative sum (CUSUM) technique, and the number of procedures required to reduce the incidence of temporary hypoparathyroidism to less than 30% was determined using the CUSUM and risk-adjusted CUSUM (RA-CUSUM) techniques. The learning curve for operation time was divided into three phases: phase 1 (the initial learning period, 1st–19th cases), phase 2 (the challenging period, 20th–121st cases), and phase 3 (the competent phase, 122nd–194th cases). To reduce the incidence of temporary hypoparathyroidism to <30% required 119 cases, and after adjustment for potential risk factors by RA-CUSUM analysis this extended to 173 cases. Technical proficiency for robotic thyroid surgery with respect to the avoidance of surgical complications probably requires a longer learning period than that required for operation time.

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Thoracoscopic Esophageal Atresia Repair in Pakistan: Early Learning Curve

Journal of Neonatal Surgery ◽

10.21699/jns.v6i4.527 ◽

2017 ◽

Vol 6 (4) ◽

pp. 78 ◽

Cited By ~ 1

Author(s):

Ali Raza Brohi ◽

Naseem Mengal ◽

Rafia Tabassum

Keyword(s):

Learning Curve ◽

Esophageal Atresia ◽

Single Incision ◽

Single Layer ◽

Early Learning ◽

Esophageal Leak ◽

Open Thoracotomy ◽

Initial Learning ◽

Thoracoscopic Repair ◽

Type C

Background: Esophageal atresia is rare congenital anomaly, which is traditionally repaired by open thoracotomy. Thoracoscopic esophageal atresia repair has evolved as an effective and safe technique.Material and Methods: This is a retrospective review of 11 cases of esophageal atresia (type C), between June 2015 to May 2016. The objective of study is to describe our initial learning curve of thoracoscopic esophageal atresia repair.Results: Out of 11 patients, initial 4 underwent video assisted technique through single incision of 2 cm to visualize the exact video-scopic anatomy and to do few steps if possible. In last 7 cases, steps were completed with both ends mobilization and intracorporeally single layer interrupted stitching of esophagus. Complications encountered in 3 patients like esophageal leak in one managed conservatively, stenosis and reflux in one patient each.Conclusion: Thoracoscopic esophageal atresia repair is challenging and demanding surgery. Every surgeon has a learning curve before successful thoracoscopic repair which requires skills and learning under supervision of experienced surgeons.

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A learning curve in using organ retractor for single-incision laparoscopic right colectomy

Scientific Reports ◽

10.1038/s41598-021-86168-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Toshio Shiraishi ◽

Tetsuro Tominaga ◽

Takashi Nonaka ◽

Kiyoaki Hamada ◽

Masato Araki ◽

...

Keyword(s):

Colon Cancer ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Learning Curve ◽

Single Incision ◽

Operation Time ◽

Perioperative Outcomes ◽

Single Incision Laparoscopic Surgery ◽

Right Colon ◽

Right Colon Cancer

AbstractSingle-incision laparoscopic surgery (SILS) has the potential to improve perioperative outcomes, including less postoperative pain, shorter operation time, less blood loss, and shorter hospital stay. However, SILS is technically difficult and needs a longer learning curve. Between April 2016 and September 2019, a total of 198 patients with clinical stage I/II right colon cancer underwent curative resection. In the case of the SILS approach, an organ retractor was usually used to overcome SILS-specific restrictions. The patients were divided into two groups by surgical approach: the SILS with organ retractor group (SILS-O, n = 33) and the conventional laparoscopic surgery group (LAC, n = 165). Clinical T status was significantly higher in the LAC group (p = 0.016). Operation time was shorter and blood loss was lower in the SILS-O group compared to the LAC group (117 vs. 197 min, p = 0.027; 10 vs. 25 mL, p = 0.024, respectively). In the SILS-O group, surgical outcomes including operation time, blood loss, number of retrieved lymph nodes, and postoperative complications were not significantly different between those performed by experts and by non-experts. Longer operation time (p = 0.041) was significantly associated with complications on univariate and multivariate analyses (odds ratio 2.514, 95%CI 1.047–6.035, p = 0.039). SILS-O was safe and feasible for right colon cancer. There is a potential to shorten the learning curve of SILS using an organ retractor.

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Learning curve for single-incision laparoscopic resection of right-sided colon cancer by complete mesocolic excision

Medicine ◽

10.1097/md.0000000000003982 ◽

2016 ◽

Vol 95 (26) ◽

pp. e3982 ◽

Cited By ~ 9

Author(s):

Chang Woo Kim ◽

Yun Dae Han ◽

Ha Yan Kim ◽

Hyuk Hur ◽

Byung Soh Min ◽

...

Keyword(s):

Colon Cancer ◽

Learning Curve ◽

Laparoscopic Resection ◽

Single Incision ◽

Complete Mesocolic Excision ◽

Mesocolic Excision

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Learning curve for robot-assisted Ivor Lewis esophagectomy

Diseases of the Esophagus ◽

10.1093/dote/doab026 ◽

2021 ◽

Author(s):

Yu Han ◽

Yajie Zhang ◽

Wentian Zhang ◽

Jie Xiang ◽

Kai Chen ◽

...

Keyword(s):

Learning Curve ◽

Complication Rate ◽

Major Complication ◽

Robot Assisted ◽

Ivor Lewis ◽

Initial Learning ◽

Cusum Analysis ◽

Technical Proficiency ◽

Major Complication Rate ◽

Two Phases

Summary This study aimed to demonstrate the learning curve of robot-assisted minimally invasive esophagectomy (RAMIE). A retrospective analysis of the first 124 consecutive patients who underwent RAMIE with intrathoracic anastomosis (Ivor Lewis) by a single surgeon between May 2015 and August 2020 was performed. An risk-adjusted cumulative sum (RA-CUSUM) analysis was applied to generate a learning curve of RAMIE considering the major complication rate, which reflected the technical proficiency. The overall 30-day morbidity rate was 38.7%, while the major complication rate was 25.8%. The learning curve was divided into two phases based on the RA-CUSUM analysis: phase I, the initial learning phase (cases 1–51) and phase II, the proficiency phase (cases 52–124). As we compared the proficiency phase with the initial learning phase, significantly decreased trends were observed in relation to the major complication rate (37.3% vs. 18.7%, P = 0.017), total operation time (330.9 ± 55.6 vs. 267.3 ± 39.1 minutes, P < 0.001), and length of hospitalization (10 [IQR, 9–14] days vs. 9 [IQR, 8–11] days, P = 0.034). In conclusion, the learning curve of RAMIE consisted of two phases, and at least 51 cases were required to gain technical proficiency.

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Learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy

World Journal of Gastroenterology ◽

10.3748/wjg.v19.i29.4786 ◽

2013 ◽

Vol 19 (29) ◽

pp. 4786 ◽

Cited By ~ 10

Author(s):

Ming-Xin Pan

Keyword(s):

Laparoscopic Cholecystectomy ◽

Learning Curve ◽

Single Incision ◽

Single Incision Laparoscopic Cholecystectomy ◽

Suture Suspension

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Research and Comparative Analysis of Build Technology Programming in Java

Mathematical Problems of Computer Science ◽

10.51408/1963-0028 ◽

2018 ◽

pp. 107-110

Author(s):

Aren Mayilyan ◽

Levon Hovsepyan

Keyword(s):

Comparative Analysis ◽

Learning Curve ◽

Initial Learning ◽

Developer Tools

Build tools have been studied in Java environment, and a comparable analysis has been done according to the following parameters: initial learning curve, the speed of different builds, complexity, plugins, documentation and community, developer tools integrity.

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