The learning curve for DVC sparing RARP with anterior reconstruction: A single surgeon experience

Background. The exact nature of learning curve of totally extraperitoneal inguinal hernia and the number required to master this technique remain controversial.Patients and Methods. We present a retrospective review of a single surgeon experience on patients who underwent totally extraperitoneal inguinal hernia repair.Results. There were 42 hernias (22 left- and 20 right-sided) in 39 patients with a mean age of48.8±15.1years. Indirect, direct, and combined hernias were present in 18, 12, and 12 cases, respectively. The mean operative time was55.1±22.8minutes. Peritoneal injury occurred in 9 cases (21.4%). Conversion to open surgery was necessitated in 7 cases (16.7%). After grouping of all patients into two groups as cases between 1–21 and 22–42, it was seen that the majority of peritoneal injuries (7 out of 9, 77.8%,P=0.130) and all conversions (P=0.001) occurred in the first 21 cases.Conclusions. Learning curve of totally extraperitoneal inguinal hernia repair can be divided into two consequent steps: immediate and late. At least 20 operations are required for gaining anatomical knowledge and surgical pitfalls based on the ability to perform this operation without conversion during immediate phase.

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Does learning curve affect perioperative safety and early functional outcomes after HoLEP? Single surgeon experience in a referral academic centre

European Urology Supplements ◽

10.1016/s1569-9056(19)33495-5 ◽

2019 ◽

Vol 18 (9) ◽

pp. e3165-e3166

Author(s):

M. Di Camillo ◽

F. Sessa ◽

R. Tellini ◽

P. Verrienti ◽

R. Campi ◽

...

Keyword(s):

Learning Curve ◽

Functional Outcomes ◽

Surgeon Experience ◽

Perioperative Safety

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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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Ultrasound-Guided Fine-Needle Biopsy of First 1000 Consecutive Thyroid Nodules: Single-Surgeon Experience

OTO Open ◽

10.1177/2473974x20929008 ◽

2020 ◽

Vol 4 (2) ◽

pp. 2473974X2092900

Author(s):

Jagdish K. Dhingra

Keyword(s):

Learning Curve ◽

Needle Biopsy ◽

Thyroid Nodules ◽

Diagnostic Yield ◽

Statistical Significance ◽

Fine Needle Biopsy ◽

Ultrasound Guided ◽

Fine Needle ◽

Surgeon Experience ◽

Chi Square Analysis

Objective To study the feasibility, safety, and learning curve of ultrasound-guided fine-needle biopsy (USGFNB) performed by a newly trained otolaryngologist in a community office in a setting. Study Design Collect USGFNB data of all thyroid nodules in a prospective manner. Setting A dedicated ultrasound clinic in a large community-based practice, operated by a single surgeon with the purpose of providing office-based point-of-care diagnostic ultrasonography and USGFNB. Subjects and Methods Data on the first 1000 unselected consecutive thyroid nodules that underwent USGFNB over a 3-year period were analyzed. Chi-square analysis was used to assess the statistical significance of characteristics of diagnostic vs nondiagnostic nodules. A multivariate regression analysis was conducted to determine nodule characteristics predictive of adequate sampling. Diagnostic yield and time efficiency data were plotted over a 3-year period to study the learning curve for the USGFNB procedure performed by an operator with no previous experience. Results A total of 1000 nodules in 734 patients including 142 males and 592 females (age range, 17-87 years) were studied. Of the patients, 188 of 734 had more than 1 nodule biopsied, with a maximum of 4 nodules biopsied in 1 setting. The procedure was successfully completed in all patients, with no major complications. A steep learning curve was observed, and adequate samples were obtained in 91.9% of the patients on the first attempt. The cystic nature of the nodule was the biggest predictor of a nondiagnostic yield. Conclusions Otolaryngologist-performed USGFNB of the thyroid is safe, effective, and desirable.

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Intraoperative perception and estimates on extent of resection during awake glioma surgery: overcoming the learning curve

Journal of Neurosurgery ◽

10.3171/2017.1.jns161811 ◽

2018 ◽

Vol 128 (5) ◽

pp. 1410-1418 ◽

Cited By ~ 9

Author(s):

Darryl Lau ◽

Shawn L. Hervey-Jumper ◽

Seunggu J. Han ◽

Mitchel S. Berger

Keyword(s):

Learning Curve ◽

Tumor Resection ◽

Extent Of Resection ◽

Neurological Deficits ◽

Language Outcomes ◽

Glioma Surgery ◽

Ample Evidence ◽

Postoperative Mri ◽

Significant Difference ◽

Surgeon Experience

OBJECTIVEThere is ample evidence that extent of resection (EOR) is associated with improved outcomes for glioma surgery. However, it is often difficult to accurately estimate EOR intraoperatively, and surgeon accuracy has yet to be reviewed. In this study, the authors quantitatively assessed the accuracy of intraoperative perception of EOR during awake craniotomy for tumor resection.METHODSA single-surgeon experience of performing awake craniotomies for tumor resection over a 17-year period was examined. Retrospective review of operative reports for quantitative estimation of EOR was recorded. Definitive EOR was based on postoperative MRI. Analysis of accuracy of EOR estimation was examined both as a general outcome (gross-total resection [GTR] or subtotal resection [STR]), and quantitatively (5% within EOR on postoperative MRI). Patient demographics, tumor characteristics, and surgeon experience were examined. The effects of accuracy on motor and language outcomes were assessed.RESULTSA total of 451 patients were included in the study. Overall accuracy of intraoperative perception of whether GTR or STR was achieved was 79.6%, and overall accuracy of quantitative perception of resection (within 5% of postoperative MRI) was 81.4%. There was a significant difference (p = 0.049) in accuracy for gross perception over the 17-year period, with improvement over the later years: 1997–2000 (72.6%), 2001–2004 (78.5%), 2005–2008 (80.7%), and 2009–2013 (84.4%). Similarly, there was a significant improvement (p = 0.015) in accuracy of quantitative perception of EOR over the 17-year period: 1997–2000 (72.2%), 2001–2004 (69.8%), 2005–2008 (84.8%), and 2009–2013 (93.4%). This improvement in accuracy is demonstrated by the significantly higher odds of correctly estimating quantitative EOR in the later years of the series on multivariate logistic regression. Insular tumors were associated with the highest accuracy of gross perception (89.3%; p = 0.034), but lowest accuracy of quantitative perception (61.1% correct; p < 0.001) compared with tumors in other locations. Even after adjusting for surgeon experience, this particular trend for insular tumors remained true. The absence of 1p19q co-deletion was associated with higher quantitative perception accuracy (96.9% vs 81.5%; p = 0.051). Tumor grade, recurrence, diagnosis, and isocitrate dehydrogenase-1 (IDH-1) status were not associated with accurate perception of EOR. Overall, new neurological deficits occurred in 8.4% of cases, and 42.1% of those new neurological deficits persisted after the 3-month follow-up. Correct quantitative perception was associated with lower postoperative motor deficits (2.4%) compared with incorrect perceptions (8.0%; p = 0.029). There were no detectable differences in language outcomes based on perception of EOR.CONCLUSIONSThe findings from this study suggest that there is a learning curve associated with the ability to accurately assess intraoperative EOR during glioma surgery, and it may take more than a decade to be truly proficient. Understanding the factors associated with this ability to accurately assess EOR will provide safer surgeries while maximizing tumor resection.

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