scholarly journals 1019 Quantified Learning Curves for Robotic Gastrointestinal Surgery

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Huttman ◽  
M Kiandee ◽  
R Lawrence ◽  
L Paynter ◽  
S Lawday ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Robotic Surgery ◽  
Operative Time ◽  
Operating Time ◽  
Gastrointestinal Surgery ◽  
Learning Curves ◽  
Descriptive Statistics ◽  
Setup Times ◽  
Control Procedure ◽  
The Mean

Abstract Aim Robotic techniques are increasingly being adopted by gastrointestinal surgeons. It is important to understand the learning curves (LCs) for robotic surgery, to protect patients from harm caused by surgeon inexperience. The aim of this study was to summarise reports of the LC for three robotic gastrointestinal procedures: cholecystectomy, oesophagectomy and Roux-en-Y gastric bypass (RYGB). Method Three systematic reviews were conducted by the trainee led RoboSurg Collaborative. Systematic searches identified reports of primary clinical research involving robotic cholecystectomy, oesophagectomy and RYGB. Articles were screened in duplicate by title, abstract and then full text. References to the LC were extracted and coded. Quantifications of the learning curve were summarised using descriptive statistics. Results 259 articles were identified: 56 measured the LC, with 23 (9%) of these calculating the number of cases required to complete the LC. The mean reported number of cases at which the LC plateaued was: 16 for oesophagectomy (N = 6, SD = 3.7), 18 for cholecystectomy (N = 5, SD = 15.1), 34 for RYGB (N = 12, SD = 24.6). The reported LCs often incorporated equipment setup times, and so represents learning of the team as well as the surgeon. These values represent points on the LC that authors deemed their surgeons to have ‘completed’ learning. Definitions for when these points occurred varied greatly but largely fell in to two categories: ‘plateau of operative time’ or ‘matching operating time of laparoscopic control procedure’. Conclusions The heterogeneity in how LCs are defined, measured, and reported highlights the need for a more standardised approach when evaluating novel techniques such as robotics.

scholarly journals 1028 How Has the Learning Curve Been Measured in Robotic Gastrointestinal Surgery?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Huttman ◽  
M Kiandee ◽  
R Lawrence ◽  
L Paynter ◽  
S Lawday ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Learning Curve ◽  
Operative Time ◽  
Graphical Representation ◽  
Gastrointestinal Surgery ◽  
Surrogate Marker ◽  
Learning Curves ◽  
Descriptive Statistics ◽  
Surrogate Markers ◽  
The Ideal

Abstract Aim Robotic surgery is increasingly being adopted by gastrointestinal surgeons. The IDEAL Collaboration has recommended evaluation of the learning curve (LC) for such surgical innovations. It is not known how learning curves have been reported for robotic gastrointestinal procedures. The aim of this study was to summarise how the LCs were measured for three robotic gastrointestinal procedures: cholecystectomy, oesophagectomy and Roux-en-Y gastric bypass (RYGB). Method Three systematic reviews conducted by the trainee led RoboSurg Collaborative identified primary clinical research involving robotic cholecystectomy, oesophagectomy and RYGB. Articles were screened in duplicate by title, abstract and then full text. References to the LC were extracted and coded. The techniques used to measure the LC were summarised using descriptive statistics. Results 259 articles were identified, of which 56 (22%) actively measured the LC. The commonest surrogate marker for performance was operative time (N = 34, 63%). Several evaluated performances using the cumulative sum of the operative times (N = 8, 14%). Complications (N = 5, 8%) and time to complete a specific surgical step (N = 4, 7%) were also used. Some authors used multiple markers (N = 4, 7%). Cases were reported individually in 48 (81%) of the LCs, whereas they were grouped in 11 (19%). 19 authors (34%) provided graphical representation of the LC. Conclusions The reporting of LCs for robotic gastrointestinal surgery was heterogeneous and lacked standardisation. There was variation in choice of surrogate markers for performance, individual versus grouped case reporting, and graphical representations. To improve the utility of LC reports, the recommendations of the IDEAL Collaboration should be implemented.

scholarly journals Open and laparoscopic approaches are associated with comparable 90-day morbidity and mortality following ERAS protocol

2020 ◽  
Author(s):  
Bhavin B. Vasavada ◽  
Hardik Patel
Keyword(s):  
Multivariate Analysis ◽  
Operative Time ◽  
Univariate Analysis ◽  
Operating Time ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Blood Products ◽  
Mortality And Morbidity ◽  
The Mean ◽  
Eras Protocol

ABSTRACTIntroductionThe aim of this study is to compare 90-day mortality and morbidity between open and laparoscopic surgeries performed in one centre since the introduction of ERAS protocols.Material and MethodsAll gastrointestinal surgeries performed between April 2016 and March 2019 at our institution after the introduction of ERAS protocols have been analysed for morbidity and mortality. The analysis was performed in a retrospective manner using data from our prospectively maintained database.ResultsWe performed 245 gastrointestinal and hepatobiliary surgeries between April 2016 and March 2019. The mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. The mean ASA score was 2.4, the mean operative time was 111 minutes and the mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall the 90-day mortality rate was 8.5% and the morbidity rate was around 9.79%. On univariate analysis morbidity was associated with a higher CDC grade of surgeries, a higher ASA grade, longer operating time, the use of more blood products, a longer hospital stay and open surgeries. HPB surgeries and luminal surgeries (non hpb gastrointestinal surgeries) were associated with 90 day post operative morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90-day mortality was predicted by the grade of surgeries, a higher ASA grade, longer operative time, the use of more blood products, open surgeries and emergency surgeries. However on multivariate analysis only the use of more blood products was independently associated with mortalityConclusionThe 90-day mortality and morbidity rates between open and laparoscopic surgeries after the introduction of ERAS protocol were similar.

Complications of Diagnostic Arteriography Performed by a Vascular Surgeon in a Recent Series of 558 Patients

Vascular ◽  
2007 ◽  
Vol 15 (2) ◽  
pp. 92-97 ◽  
Author(s):  
Ali F. AbuRahma ◽  
Michael Elmore ◽  
John Deel ◽  
Bandy Mullins ◽  
John Hayes
Keyword(s):  
Operative Time ◽  
Perioperative Complications ◽  
Operating Time ◽  
Major Complication ◽  
Aortic Aneurysms ◽  
Complication Rates ◽  
Vascular Surgeon ◽  
Technical Success Rate ◽  
Abdominal Aortic ◽  
The Mean

This article analyzes the complication rates of diagnostic arteriographies performed by a single vascular surgeon and compares them to those previously published by interventional radiologists. Five hundred fifty-eight consecutive patients who underwent diagnostic arteriographies were analyzed. A modification of one study's criteria was used to compile perioperative complications. The technical success rate was 99%. These included 345 aortoiliofemoral arteriograms with runoff, 64 aortoiliofemoral arteriograms for abdominal aortic aneurysms, 83 aortoiliofemoral arteriograms with contralateral selective iliacs, 35 aortoiliofemoral arteriograms with carotids, and 27 aortoiliofemoral arteriograms with selective visceral/renal. Femoral artery puncture was used in 93%, and left brachial artery in 7%. The mean amount of contrast was 97 cc and the mean operative time was 25 minutes. The overall complication rate was 3.8% (1.3% major), which was comparable to what was published previously (1.9% and 2.9%) but superior to what we published previously as performed by our radiologists (7%, p <.001). A logistic regression could not find any variables that were significant for the prediction of a major complication. However, increased age, a longer operating time (≥ 30 minutes), and smoking were associated with an increase in overall complications. It was determined that diagnostic arteriography can be done safely by experienced vascular surgeons with low complication rates that compare favorably with what was published by interventional radiologists.

scholarly journals Weight Loss after Sleeve Gastrectomy in Super Superobesity

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
J.-M. Catheline ◽  
M. Fysekidis ◽  
R. Dbouk ◽  
A. Boschetto ◽  
H. Bihan ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Operative Time ◽  
Postoperative Mortality ◽  
Gastric Fistula ◽  
Second Stage ◽  
The Mean ◽  
Complete Situs Inversus

Objective. This prospective study evaluated laparoscopic sleeve gastrectomy for its safety and efficiency in excess weight loss (%EWL) in super superobese patients (BMI>60 Kg/m2).Results. Thirty patients (33 women and 7 men) were included, with mean age of 35 years (range 18 to 59). Mean preoperative BMI was 66 Kg/m2(range 60 to 85). The study included one patient with complete situs inversus and 4 (14%) with previous restrictive gastric banding. The mean operative time was 120 minutes (range 80 to 220 min) and the mean hospital stay was 7.5 days (4 to 28 days). There was no postoperative mortality or need for a laparotomy conversion. Two subphrenic hematomas, one gastric fistula, and one pulmonary embolism, were the major complications. After 18 months 17 (77%) had sufficient weight loss and six had insufficient results, leading to either re-sleeve gastrectomy (3), or gastric bypass (2). Three years after the initial laparoscopic sleeve gastrectomy, the mean EWL was 51% (range 21 to 82).Conclusion. The laparoscopic sleeve gastrectomy is a safe and efficient operating procedure for treating super superobesity. In the case of insufficient weight loss, a second-stage operation like resleeve gastrectomy or gastric bypass can be proposed.

scholarly journals Role of the Laparoscopic Approach for Complex Urologic Surgery in the Era of Robotics

2021 ◽  
Vol 10 (9) ◽  
pp. 1812
Author(s):  
Iulia Andras ◽  
Angelo Territo ◽  
Teodora Telecan ◽  
Paul Medan ◽  
Ion Perciuleac ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Operative Time ◽  
Vena Cava ◽  
Laparoscopic Approach ◽  
Hepatic Veins ◽  
Combined Approach ◽  
Urological Procedures ◽  
The Mean ◽  
Complications Rate

(1) Introduction: The advent of robotic surgery led to the assumption that laparoscopic surgery would be replaced entirely. However, the high costs of robotic surgery limit its availability. The aim of the current study was to assess the feasibility of the 3D laparoscopic approach for the most complex urological procedures. (2) Materials and methods: We included in the current study all patients who had undergone complex 3D laparoscopic procedures in our department since January 2017, including radical nephrectomy (LRN) using a dual combined approach (19 patients), radical nephroureterectomy (LRNU) with bladder cuff excision (13 patients), and radical cystectomy (LRC) with intracorporeal urinary diversion (ICUD) (21 patients). (3) Results: The mean operative time was 345/230/478 min, the complications rate was 26%/30.76%/23.8% and positive surgical margins were encountered in 3/1/1 patients for the combined approach of LRN/LRNU/LRC with ICUD, respectively. A single patient was converted to open surgery during LRN due to extension of the vena cava thrombus above the hepatic veins. After LRC, sepsis was the most common complication and 8 patients were readmitted at a mean of 15.5 days after discharge. (4) Conclusions: In the era of robotic surgery, laparoscopy remains a plausible alternative for most complex oncological cases.

Robot-Assisted Laparoscopic Fundoplications in Pediatric Surgery: Experience Review

2017 ◽  
Vol 29 (02) ◽  
pp. 173-178 ◽  
Author(s):  
Laurent Fourcade ◽  
Sarah Amar ◽  
Khalid Alzahrani ◽  
Ann-Rose Cook ◽  
Karim Braïk ◽  
...  
Keyword(s):  
Learning Curve ◽  
Pediatric Surgery ◽  
Operative Time ◽  
Operating Time ◽  
Laparoscopic Approach ◽  
Robot Assisted ◽  
Postoperative Rehabilitation ◽  
New Approach ◽  
Open Procedure ◽  
The Mean

Introduction Laparoscopic fundoplicature for gastroesophageal reflux disease has become the gold standard because of the improvement of postoperative rehabilitation compared with the open procedure. The robot-assisted surgery has brought new advantages for the patient and the surgeon compared with laparoscopy. We studied this new approach and the learning curve. Materials and Methods Sixty robot-assisted fundoplicatures were performed in two university pediatric surgery centers. Data of the patients were recorded, including peroperative data (operation length and complications), postoperative recoveries, and clinical evolution. The learning curve was evaluated retrospectively and each variable was compared along this learning curve. Results We observed a flattening of the learning curve after the 20th case for one surgeon. The mean operative time decreased significantly to 80 ± 10 minutes after 20 cases. There were no conversions to an open procedure. A revision surgery was indicated for 4.7% of the patients by a surgical robot-assisted laparoscopic approach. Conclusion The robotic system appears to add many advantages for surgical ergonomic procedures. There is a potential benefit in operating time with a short technical apprenticeship period. The setting up system is easy with a short docking time.

A prospective study of the components of operating room utilisation time for robotic urological surgery in a public teaching hospital setting

2020 ◽  
pp. 205141582094271
Author(s):  
Mark P Broe ◽  
Jarlath M Bolger ◽  
Sarah Norton ◽  
Silviu David ◽  
John C Coffey ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Operating Room ◽  
Outcome Measures ◽  
Operative Time ◽  
Significant Proportion ◽  
Learning Curves ◽  
Secondary Outcome ◽  
Port Placement ◽  
Depth Analysis ◽  
Set Up

Introduction and aim: Although there are several publications on learning curves and patient outcomes in robotic surgery, the literature is lacking in depth analysis of operating room (OR) utilisation time which is an expansive healthcare resource for robotic surgery, especially in urology. Thus, we aimed to study individual operating theatre component times in order to improve performance and efficacy. Method: A cross-specialty robotic-surgery programme was established at our institution in mid-June 2016 using the daVinci Xi dual console robot. A detailed database was established before initiation of the project. The times taken for each element of the preparation and completion of robotic urological procedure were collected by an independent nurse for all the procedures. Primary outcome measures were total OR time, operative time and console time. Secondary outcome measures were port placement time, set-up time and non-operative time. The statistical significance was calculated by using the Student’s t-test, Fisher’s exact test or Wilcoxon matched pairs test where appropriate. Result: Thirty consecutive urological cases were analysed. Mean total OR time, operative time and console time were 320.86 (range 172–485), 235.7 (124–295) and 152.3 min (66–219) respectively. Console time accounted for about less than half of OR time. A significant proportion of OR time was non-operative time (almost one third). After an initial learning curve, set-up time was consistently maintained for most robotic procedures. Conclusions: The findings of this study have three implications for clinical practice. Firstly, console time contributed about half of the OR time. This can be optimised with experience. Secondly robot set-up time is likely to reduce with the experience of the whole team. Finally, non-operative OR time constitute a significant one third of the OR time during robotic surgery. Efforts to reduce non-surgical aspect of OR time will have potential to reduce cost and improve efficiency. Level of Evidence: 4

scholarly journals Robotically-Assisted Coronary Artery Bypass Grafting

2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Thierry A. Folliguet ◽  
Alain Dibie ◽  
François Philippe ◽  
Fabrice Larrazet ◽  
Michel S. Slama ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Robotic Surgery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Operating Time ◽  
Minimal Invasive ◽  
Hospital Death ◽  
The Mean ◽  
One Year

Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery.Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart.Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB), and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB) grafting. Nine patients (16%) were converted to open techniques. The mean total operating time for TECAB was minutes and for MIDCAB was minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50%) in 6 patients. Overall permeability was 92%.Conclusions. Robotic surgery can be performed with promising results.

Transoral robotic surgery for sellar tumors: first clinical study

2017 ◽  
Vol 127 (4) ◽  
pp. 941-948 ◽  
Author(s):  
Dorian Chauvet ◽  
Stéphane Hans ◽  
Antoine Missistrano ◽  
Celeste Rebours ◽  
Wissame El Bakkouri ◽  
...  
Keyword(s):  
Side Effects ◽  
Robotic Surgery ◽  
Operative Time ◽  
Da Vinci ◽  
Sella Turcica ◽  
Transoral Robotic Surgery ◽  
Da Vinci Surgical System ◽  
The Mean ◽  
Vinci Surgical System ◽  
Surgical System

OBJECTIVEThe aim of this study was to confirm the feasibility of an innovative transoral robotic surgery (TORS), using the da Vinci Surgical System, for patients with sellar tumors. This technique was designed to offer a new minimally invasive approach, without soft-palate splitting, that avoids the rhinological side effects of classic endonasal approaches.METHODSThe authors performed a prospective study of TORS in patients with symptomatic sellar tumors. Specific anatomical features were required for inclusion in the study and were determined on the basis of preoperative open-mouth CT scans of the brain. The main outcome measure was sellar accessibility using the robot. Resection quality, mean operative time, postoperative changes in patients' vision, side effects, and complications were additionally reported.RESULTSBetween February and May 2016, 4 patients (all female, mean age 49.5 years) underwent TORS for resection of sellar tumors as participants in this study. All patients presented with symptomatic visual deficits confirmed as bitemporal hemianopsia. All tumors had a suprasellar portion and a cystic part. In all 4 cases, the operation was performed via TORS, without the need for a second surgery. Sella turcica accessibility was satisfactory in all cases. In 3 cases, tumor resection was complete. The mean operative time was 2 hours 43 minutes. Three patients had a significant visual improvement at Day 1. No rhinological side effects or complications in patients occurred. No pathological examination was performed regarding the fluid component of the tumors. There was 1 postoperative delayed CSF leak and 1 case of transient diabetes insipidus. Side effects specific to TORS included minor sore throat, transient hypernasal speech, and 1 case of delayed otitis media. The mean length of hospital stay and mean follow up were 8.25 days and 82 days, respectively.CONCLUSIONSTo our knowledge, this is the first report of the surgical treatment of sellar tumors by means of a minimally invasive TORS. This approach using the da Vinci Surgical System seems feasible and constitutes an innovative neurosurgical technique that may avoid the adverse side effects and technical disadvantages of the classic transsphenoidal route. Moreover, TORS allows an inferosuperior approach to the sella turcica, which is a key point, as the tumor is approached in the direction of its growth.

scholarly journals COMPARATIVE STUDY OF ENDOSCOPIC AND MICROSCOPIC ASSISTED MYRINGOPLASTY IN TIRUMALA HOSPITALS, KADAPA

2019 ◽  
Vol 3 (5) ◽  
Author(s):  
Dr. P. Surendra Babu
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Operative Time ◽  
Operating Time ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Fascia Graft ◽  
Significant Difference ◽  
The Mean

Objective: The main aim of the study is to assess the operative time, graft uptake and audiological gain and post-operative scar in the group of the patients undergoing the endoscope assisted and the microscope assisted myringoplasty in Tirumala Hospital, Kadapa. Material and Methods: Myringoplasty or type-1 tympanoplasty was performed by either the endoscope or the microscope assistance. Postaural approach was undertaken for microscope assisted myringoplasty. Underlay technique of myringoplasty was performed using temporalis fascia graft in all the patients suffering from the inactive mucosal chronic otitis media. Post operative evaluation was done in terms of operative time, graft uptake and audiological gain. The patients were followed up for a period of 6 months. The study was longitudinal in nature and comprised of 100 patients suffering from the chronic otitis media inactive mucosal disease. The patients are divided into two groups consisting of 50 in each group. One group of patients have undergone microscopic assisted myringoplasty one group undergone endoscopic assisted myringoplasty and were followed up regularly.  Study period is one year from January 2016 to December 2016 attending outpatient otolaryngology department were included in the study. Results: The operative time in the patients undergoing the endoscope assisted myringoplasty(EAM) was 45minutes whereas it was 60 minutes in the patients undergoing the microscope assisted myringoplasty(MAM). The tympanic membrane graft uptake and audiological gain was assessed at 1 month, 3months and 6 months post operatively. The successful closure of the tympanic membrane perforation was higher with the endoscope assisted myringoplasty as compared to the microscope assisted myringoplasty at 1 month, 3 months and 6 months of follow up. The mean audiological gain following myringoplasty with both the techniques used was noted. The mean audiological gain was found to be marginally better with the endoscope assisted myringoplasty at follow up of 1, 3 and 6 months as compared to the microscope assisted myringoplasty. Conclusion: The operative time was less in the endoscope assisted technique as compared to the microscope assisted technique. The post operative morbidity (evaluated in terms of post operative scar) was less in the group of patients undergoing the Transcanal endoscope assisted as compared to microscope assisted myringoplasty. There was no significant difference in either graft uptake or post-operative audiological gain in the patients undergoing myringoplasty by endoscope assisted and microscope assisted technique. The endoscope assisted myringoplasty has advantages of better assessment of ossicular chain and in the patients with canal overhang it improves the visualisation of the margins of the perforation thus obviating the need for canalplasty. Thus the endoscope assisted myringoplasty can be used as a preferred alternative to the conventional microscope assisted myringoplasty, with better post operative results and reduced operating time and morbidity of the surgical procedure. Keywords: Chronic otitis media (COM); Myringoplasty; Endoscope assisted myringoplasty; Microscope assisted myringoplasty.

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