Effectiveness of Robotic Lobectomy—Outcome and Learning Curve in a High Volume Center

2018 ◽  
Vol 67 (07) ◽  
pp. 573-577 ◽  
Author(s):  
Danjouma Housmanou Cheufou ◽  
Khaled Mardanzai ◽  
Till Ploenes ◽  
Dirk Theegarten ◽  
Georgios Stamatis ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Thoracic Surgery ◽  
Learning Curve ◽  
Operative Time ◽  
Thoracoscopic Surgery ◽  
High Volume ◽  
Tumor Stage ◽  
Minimal Invasive ◽  
Complication Rates ◽  
Single Center Experience

Background Robotic surgery has been developed as a sophisticated tool to expand possibilities in minimal invasive surgery. The learning curve for this method is short in various surgical fields; however, limited data exist on the learning curve in robotic thoracic surgery. Methods This study analyzes a single center experience of robotic lobectomies using a prospectively kept database. Perioperative data and outcome of patients during the learning curve were compared with patients operated with increased institutional experience. The learning curve was defined as the initial 20 lobectomies. Results Sixty-four robotic lobectomies were performed between January 2014 and February 2017. Indications, preoperative lung functions, comorbidities, patient age, and tumor stage were comparable between patients operated during the learning curve and thereafter. The mean operative time could be significantly reduced after the learning curve (286 ± 86 vs. 211 ± 62 minutes; p = 0.0003). The conversion rate dropped from 4 of 20 (20%) during the learning curve to 2 of 44 (4.5%, p = 0.07) thereafter. Chest tube duration (4.3 ± 2.9 vs. 3.8 ± 2.1 days) and hospital stay (8.3 ± 3.4 vs. 7.9 ± 4.5 days) were not different in the two phases. The number of resected lymph nodes increased from 11.2 ± 6.8 to 13.9 ± 6.5 (p = 0.0797). Lymph node upstaging was achieved in 8 (12.9%) cases. Ninety-day mortality was 0%, and 2-year overall survival was 83%. Conclusions Robotic thoracic surgery can be safely performed and trained with low complication rates and contributes to the extension of minimal invasive thoracic surgery. The initial learning curve in our experience is overcome after 20 cases. However, to become proficient in more advanced procedures and to further reduce operative time, additional training is required. Prospective studies are required to clearly determine the role of robotic surgery in comparison to the video-assisted thoracoscopic surgery (VATS) procedures.

scholarly journals Robotic pulmonary lobectomy for lung cancer treatment: program implementation and initial experience

2016 ◽  
Vol 42 (3) ◽  
pp. 185-190 ◽  
Author(s):  
Ricardo Mingarini Terra ◽  
Pedro Henrique Xavier Nabuco de Araujo ◽  
Leticia Leone Lauricella ◽  
José Ribas Milanez de Campos ◽  
Herbert Felix Costa ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Thoracic Surgery ◽  
Thoracoscopic Surgery ◽  
Sao Paulo ◽  
Pathological Examination ◽  
São Paulo ◽  
Pulmonary Lobectomy ◽  
Video Assisted ◽  
Tertiary Teaching ◽  
Video Assisted Thoracoscopic Surgery

ABSTRACT Objective: To describe the implementation of a robotic thoracic surgery program at a public tertiary teaching hospital and to analyze its initial results. Methods: This was a planned interim analysis of a randomized clinical trial aimed at comparing video-assisted thoracoscopic surgery and robotic surgery in terms of the results obtained after pulmonary lobectomy. The robotic surgery program developed at the Instituto do Câncer do Estado de São Paulo, in the city of São Paulo, Brazil, is a multidisciplinary initiative involving various surgical specialties, as well as anesthesiology, nursing, and clinical engineering teams. In this analysis, we evaluated the patients included in the robotic lobectomy arm of the trial during its first three months (from April to June of 2015). Results: Ten patients were included in this analysis. There were eight women and two men. The mean age was 65.1 years. All of the patients presented with peripheral tumors. We performed right upper lobectomy in four patients, right lower lobectomy in four, and left upper lobectomy in two. Surgical time varied considerably (range, 135-435 min). Conversion to open surgery or video-assisted thoracoscopic surgery was not necessary in any of the cases. Intraoperative complications were not found. Only the first patient required postoperative transfer to the ICU. There were no deaths or readmissions within the first 30 days after discharge. The only postoperative complication was chest pain (grade 3), in two patients. Pathological examination revealed complete tumor resection in all cases. Conclusions: When there is integration and proper training of all of the teams involved, the implementation of a robotic thoracic surgery program is feasible and can reduce morbidity and mortality.

scholarly journals Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion

2013 ◽  
Vol 35 (2) ◽  
pp. E7 ◽  
Author(s):  
Pedro S. Silva ◽  
Paulo Pereira ◽  
Pedro Monteiro ◽  
Pedro A. Silva ◽  
Rui Vaz
Keyword(s):  
Minimally Invasive ◽  
Learning Curve ◽  
Interbody Fusion ◽  
Operative Time ◽  
Pedicle Screws ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Adjacent Level ◽  
Negative Exponential

Object Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has the potential advantage of minimizing soft-tissue damage and reducing recovery time compared to open procedures. A steep learning curve has been described for the technique. The aim of the present study was to define the learning curve that describes the progress of a single surgeon performing the MI-TLIF. Methods One hundred fifty consecutive patients with degenerative lumbar disease who underwent 1- or 2-level MI-TLIF were included in the study. Operative time, corrected operative time per level, and complications were analyzed. The learning curve was assessed using a negative exponential curve-fit regression analysis. Results One hundred ten patients underwent 1-level and 18 patients underwent 2-level MI-TLIF; the remaining 22 underwent a single-level procedure plus an ancillary procedure (decompression at adjacent level, vertebral augmentation through fenestrated pedicle screws, interspinous device at adjacent level). Negative exponential curves appropriately described the relationship between operative time and experience for 1-level surgery and after correction of operative time per level (R2 = 0.65 and 0.57). The median operative time was 140 minutes (interquartile range 120–173 minutes), and a 50% learning milestone was achieved at Case 12; a 90% learning milestone was achieved at Case 39. No patient required transfusion in the perioperative period. The overall complication rate was 12.67% and the most frequent complication was a dural tear (5.32%). Before the 50% and 90% learning milestones, the complication rates were 33% and 20.51%, respectively. Conclusions The MI-TLIF is a reliable and effective option for lumbar arthrodesis. According to the present study, 90% of the learning curve can be achieved at around the 40th case.

scholarly journals Global Benchmark Values for Laparoscopic Roux-en-Y-Gastric Bypass: a Potential New Indicator of the Surgical Learning Curve

2020 ◽  
Author(s):  
Guillaume Giudicelli ◽  
Michele Diana ◽  
Mickael Chevallay ◽  
Benjamin Blaser ◽  
Chloé Darbellay ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Learning Curve ◽  
Operative Time ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Morbidity Rate ◽  
Bariatric Surgeon ◽  
Senior Surgeon ◽  
Surgical Learning

Abstract Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a technically demanding procedure. The learning curve of LRYGB is challenging and potentially associated with increased morbidity. This study evaluates whether a general laparoscopic surgeon can be safely trained in performing LRYGB in a peripheral setting, by comparing perioperative outcomes to global benchmarks and to those of a senior surgeon. Methods All consecutive patients undergoing primary LRYGB between January 2014 and December 2017 were operated on by a senior (A) or a trainee (B) bariatric surgeon and were prospectively included. The main outcome of interest was all-cause morbidity at 90 days. Perioperative outcomes were compared with global benchmarks pooled from 19 international high-volume centers and between surgeons A and B for their first and last 30 procedures. Results The 213 included patients had a mean all-cause morbidity rate at 90 days of 8% (17/213). 95.3% (203/213) of the patients were uneventfully discharged after surgery. Perioperative outcomes of surgeon B were all within the global benchmark cutoffs. Mean operative time for the first 30 procedures was significantly shorter for surgeon A compared with surgeon B, with 108.6 min (± 21.7) and 135.1 min (± 28.1) respectively and decreased significantly for the last 30 procedures to 95 min (± 33.7) and 88.8 min (± 26.9) for surgeons A and B respectively. Conclusion Training of a new bariatric surgeon did not increase morbidity and operative time improved for both surgeons. Perioperative outcomes within global benchmarks suggest that it may be safe to teach bariatric surgery in peripheral setting.

scholarly journals Surgeon-Powered Robotics in Thoracic Surgery; An Era of Surgical Innovation and Its Benefits for the Patient and Beyond

2020 ◽  
Vol 7 ◽  
Author(s):  
Jason Trevis ◽  
Nicholas Chilvers ◽  
Kathrin Freystaetter ◽  
Joel Dunning
Keyword(s):  
Robotic Surgery ◽  
Minimally Invasive ◽  
Thoracic Surgery ◽  
Thoracoscopic Surgery ◽  
Surgical Innovation ◽  
Video Assisted ◽  
3D Camera ◽  
Minimally Invasive Thoracic Surgery ◽  
Video Assisted Thoracoscopic Surgery

Following its introduction in 1992, the growth of minimally invasive thoracic surgery was initially hampered by the lack of specialized instruments, impeded visualization and stapling. However, in subsequent years these challenges were somewhat overcome and video-assisted thoracoscopic surgery (VATS) became the preferred modality of many centers. More recently, robotic surgery has come to the fore. Whilst it offers outstanding precision via robotic wristed instruments, robotic surgery is expensive and has safety implications as the surgeon is away from the patient's side. Wristed VATS instruments offer a new, exciting alternative. By placing the robotic-like wristed instruments in the hands of the surgeon, a concept we call surgeon-powered robotics, the benefits of robotic surgery can be achieved by the patient's side. We describe our experience of the ArtiSential® wristed instruments and discuss the benefits and challenges of this technology. By combining wristed instruments with the latest surgeon-controlled 3D camera technology, surgeon-powered robotics is an affordable reality.

Video-assisted thoracoscopic thymectomy for thymoma: a single-center experience

2018 ◽  
Vol 26 (3) ◽  
pp. 207-211 ◽  
Author(s):  
Giang Truong Nguyen ◽  
Trung Ngoc Nguyen ◽  
Nam Van Nguyen ◽  
Kien Trung Nguyen ◽  
Anh Viet Le
Keyword(s):  
Myasthenia Gravis ◽  
Operative Time ◽  
Thoracoscopic Surgery ◽  
Military Hospital ◽  
Video Assisted ◽  
Single Center Experience ◽  
Early Results ◽  
The Mean ◽  
Video Assisted Thoracoscopic Surgery

Background Thymoma is a primary tumor derived from the epithelial cells of the thymus, which is commonly seen in the mediastinum. Surgical thymectomy is the radical treatment for thymoma. The recent introduction of video-assisted thoracoscopic surgery has improved the quality of thymectomy surgery. The clinical characteristics of thymoma and the outcomes of video-assisted thoracoscopic thymectomy in Vietnamese patients are still lacking. The objectives of this study were to investigate the clinical and laboratory characteristics of thymoma and to evaluate the early results of video-assisted thoracoscopic thymectomy for thymoma in Vietnamese patients. Methods All 53 thymoma patients with or without myasthenia gravis who underwent video-assisted thoracoscopic thymectomy in Military Hospital 103, Vietnam, from October 2013 to July 2017 were included. Results The mean age was 46.5 7.1 years, and the female/male ratio was 1.2:1. Myasthenia gravis, mostly stage IIA, was present in 84.9% of patients. There was no hospital mortality or major postoperative complication. The mean operative time was 65 min, intensive care unit stay was 22 ± 5 h, and postoperative hospital stay was 7.5 ± 1.7 days. Conclusion Thoracoscopic thymectomy for thymoma in Vietnamese patients achieved improved cosmesis and was safe for both non-myasthenia gravis and myasthenia gravis patients.

435 The learning curve for robotic partial nephrectomy in a high volume robotic surgery centre

2014 ◽  
Vol 13 (1) ◽  
pp. e435
Author(s):  
A. Kadirvelarasan ◽  
O.D. Nehikhare ◽  
P.D. Sturch ◽  
A. Patel ◽  
M. Brown ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Learning Curve ◽  
Partial Nephrectomy ◽  
High Volume ◽  
Robotic Partial Nephrectomy

scholarly journals Carotid Artery Stenting – Strategies to Improve Procedural Performance and Reduce the Learning Curve

2013 ◽  
Vol 8 (1) ◽  
pp. 50 ◽  
Author(s):  
Willem IM Willaert ◽  
Isabelle Van Herzeele ◽  
◽  
Keyword(s):  
Carotid Artery ◽  
Learning Curve ◽  
Carotid Artery Stenting ◽  
Randomised Controlled Trials ◽  
Stroke Risk ◽  
Minimal Invasive ◽  
Complication Rates ◽  
Complex Procedure ◽  
Low Volume ◽  
Randomised Controlled

Carotid artery stenting (CAS) remains an appealing intervention to reduce the stroke risk because of its minimal invasive nature. Nevertheless, landmark randomised controlled trials have not been able to resolve the controversies surrounding this complex procedure as the peri-operative stroke risk in a non-selected patient population still seems to be higher after CAS in comparison to carotid endarterectomy. What is more, these trials have highlighted that patient outcome after CAS is influenced by patient- and operator-dependant factors. The CAS procedure exhibits a definitive learning curve resulting in higher complication rates if the procedure is performed by inexperienced interventionists or in low-volume centres. This article will outline strategies to improve the performance of physicians carrying out the CAS procedure by means of proficiency-based training, credentialing, virtual reality rehearsal and optimal patient selection.

scholarly journals Defining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive CenterDefining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive Center

2020 ◽  
Author(s):  
Mingzhu Cao ◽  
Danming You ◽  
Sichen Li ◽  
Yixuan Wu ◽  
Haiying Liu ◽  
...  
Keyword(s):  
Learning Curve ◽  
Operative Time ◽  
Transvaginal Ultrasound ◽  
Phase 1 ◽  
High Volume ◽  
Oocyte Retrieval ◽  
Phase 2 ◽  
Ultrasound Guided ◽  
Phase 3 ◽  
Retrieval Efficiency

Abstract Objective: The objective of this study was to determine the novice trainee’s learning curve for oocytes retrieval procedure through assessment of oocytes retrieval efficiency, operative time and other operative characteristics. Methods: This retrospective cohort study included 200 consecutive patients undergoing transvaginal ultrasound guided oocytes retrieval procedure. Those patients underwent oocyte retrieval procedure by a single operator and one experienced supervisor. Their clinical data, including demographic data, ovarian stimulation cycle information, surgical procedure, and laboratory data were collected over 3 months. CUSUM analyses based on the operative time were performed to determine the learning curve. Results: The mean operative time was 10.10 min. Based on the CUSUM plot of operative time, the learning curve can be divided into three separated phases, phase 1 (case 1 to case 49) was learning phase, phase 2 (case 50 to case 130) was acquisition phase, and phase 3 (case 131 to case 200) was proficiency phase. The operative time was significantly shortened from phase 1 to phase 3 (phase 1, 13.37 ± 4.83min; phase 2, 10.21 ± 3.30 min; phase 3, 7.67 ± 3.24 min, P < 0.001). The oocyte retrieval efficiency was also notably improved from phase 1 to phase 3 (78.2% to 100% based on method 1 to determine oocyte retrieval efficiency, and 104.2% to 121.1% based on method 2 to determine oocyte retrieval efficiency). The retrieved oocytes number, the fertilization rate, clinical pregnancy rate among the three phases showed no significant differences. No patients had severe adverse events. As determined by multiple linear regression, learning phase is the only independent predictor of oocyte retrieval efficiency. Conclusion: Trainees practice transvaginal ultrasound guided oocytes retrieval are expected to achieve a stabilized procedure over consecutive training cases, with acquisition of the skills at 49 cases, and proficiency at 130 cases. Cumulative operative experience can improve the operative time and oocytes retrieval efficiency, but showed minimal influence on retrieved oocytes number and reproductive outcomes.

Comparison of open and robotic nephron sparing surgery: a single centre experience

2016 ◽  
Vol 10 (1) ◽  
pp. 28-35
Author(s):  
Clare R Jelley ◽  
Kurukula ASH Kurukulaarachchi ◽  
Luke Forster ◽  
Harry Bardgett ◽  
Rajindra Singh ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Hospital Stay ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
High Volume ◽  
Robotic Partial Nephrectomy ◽  
Complication Rates ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss

Objective: To compare robotic partial nephrectomy (RAPN) with open partial nephrectomy (OPN) to assess efficacy and impact of learning curve. Methods: From 2010 to 2015 159 patients had a partial nephrectomy (82 OPN and 77 RAPN). All data were collected prospectively. We compared the demographics, peri and postoperative outcomes. Results: Mean age was 60 years in both groups; 59% of patients were men. Tumour size was larger in the open group (34 mm vs 30 mm; P<0.08), but RENAL nephrometry scores greater than 6 were comparable (over 60%). Mean ischaemic time was longer in the RAPN group (18 vs 13 minutes; P<0.04) but complication rates were similar. The RAPN cohort had a reduced estimated blood loss (100 ml vs 300 ml; P<0.01) and shorter median hospital stay (2 vs 5 days; P<0.01). Only two patients in each group were margin positive. The RAPN cohort demonstrated reduced estimated blood loss and a trend towards more complex tumours with increasing learning curve. Conclusion: RAPN is superior to OPN in terms of reduced hospital stay and estimated blood loss without compromising oncological outcomes. This service can be delivered safely and effectively in a low to medium volume cancer centre; these results are similar to published figures from high volume international centres.

Sign in / Sign up

Export Citation Format

Share Document