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 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 Learning curve for laparoscopic Roux-en-Y gastric bypass based on the experience of a newly created bariatric center

2020 ◽  
Vol 92 (4) ◽  
pp. 23-30
Author(s):  
Jadwiga Dworak ◽  
Michał Wysocki ◽  
Anna Rzepa ◽  
Michał Pędziwiatr ◽  
Dorota Radkowiak ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Gastric Bypass ◽  
Adverse Events ◽  
Learning Curve ◽  
Operative Time ◽  
Perioperative Complications ◽  
Safe Procedure ◽  
Experienced Surgeon ◽  
Institutional Learning ◽  
Complications And Mortality

ntroduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common treatments for morbid obesity. The learning curve for this procedure is 50–75 cases for an independent surgeon, and it is considered the most important factor in decreasing complications and mortality. We present our experience and learning curve with LRYGB for a newly established bariatric center in Poland. Material and methods: A prospectively collected database containing 285 LRYGB procedures performed in the II Department of General Surgery of the Jagiellonian University MC in Krakow between 06.2010 and 03.2019 was retrospectively reviewed. Patients were divided into groups of 30 (G1–G10) in the order of the procedures performed by each surgeon. The study analyzed the course of the operation and patient hospitalization, comparing those groups. Learning curve for the newly created bariatric center was established. Results: Operative time in G1–G3 differed significantly from G4–G10 (P < 0.0001). The stabilization point was the 90th procedure. Perioperative complications were observed in 36 (12.63%) patients. Perioperative complications, intraoperative difficulties and adverse events did not differ importantly among groups. Liberal use of “conversions of the operator” from a surgeon to a senior surgeon provides reasonable safety and prevents complications. Conclusions: The institutional learning process stabilization point for LRYGB in a newly established bariatric center is around the 90th operation. LRYGB can be a safe procedure from the very beginning in newly established bariatric centers. Specific bariatric training with active proctoring by an experienced surgeon in a bariatric centre can improve the laparoscopic gastric bypass outcome during the learning curve.

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.

Minimally Invasive Pediatric Surgery: The Learning Curve

2020 ◽  
Vol 30 (02) ◽  
pp. 172-180
Author(s):  
Marie Uecker ◽  
Joachim F. Kuebler ◽  
Benno M. Ure ◽  
Nagoud Schukfeh
Keyword(s):  
Postoperative Complications ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Surgical Procedures ◽  
Operative Time ◽  
Learning Curves ◽  
Current Evidence ◽  
Stenosis Rate ◽  
Mucosal Perforation

AbstractThe use of minimally invasive surgery (MIS) in pediatric patients has increased over the past decades. The process of mastering a new procedure is termed the learning curve, during which the ability to operate increases but poorer outcomes are produced. We aim to analyze the current evidence on learning curves in pediatric MIS and evaluate its impact on patient's clinical outcomes. A systematic literature search was performed for studies listed on PubMed that reported on the learning curve for MIS surgical procedures. Studies were included if they stated the number of procedures required to reach a consistency in outcomes or if they compared outcomes between early and late period of MIS experience regarding the endpoints operative time, conversions, and intra-/postoperative complications. A total of 22 articles reporting on 11 surgical procedures were included in the study. Most authors reported a significant decrease in operative time as well as peri- and postoperative complications with increasing experience of the surgeon. Complications ranged from minor to major, the latter being especially severe for patients receiving pyloromyotomy (5–7% higher risk of mucosal perforation), esophageal atresia repair (15% higher leakage rate and 19–77% higher stenosis rate), or Kasai portoenterostomy (26–35% more liver transplants in the first year after surgery) during the learning curve period. Pediatric MIS comes with a considerable learning curve that may have a significant impact on the patient's clinical outcomes. Efforts should be made to minimize the effect of the learning curve on the patients.

Establishing a successful rat model of duodenal- jejunal bypass: A detailed guide

2018 ◽  
Vol 53 (4) ◽  
pp. 362-371
Author(s):  
Elina Akalestou ◽  
Laurent Genser ◽  
Francesco Villa ◽  
Ioannis Christakis ◽  
Shilpa Chokshi ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Learning Curve ◽  
Experimental Model ◽  
Glucose Homeostasis ◽  
Bypass Surgery ◽  
Operative Time ◽  
Gastric Bypass Surgery ◽  
Technical Aspects ◽  
Operative Care ◽  
Jejunal Bypass

Gastric bypass surgery, an operation that restricts the stomach and bypasses the duodenum and part of the jejunum, results in major improvement or remission of type 2 diabetes. Duodenual-jejunal bypass was developed by one of the authors (FR) as an experimental, stomach-sparing variant of gastric bypass surgery to investigate weight-independent mechanisms of surgical control of diabetes. Duodenual-jejunal bypass has been shown to improve various aspects of glucose homeostasis in rodents and in humans, thus providing an experimental model for investigating mechanisms of action of surgery and elusive aspects of gastrointestinal physiology. Performing duodenual-jejunal bypass in rodents, however, is associated with a steep learning curve. Here we report our experience with duodenual-jejunal bypass and provide practical tips for successful surgery in rats. Duodenual-jejunal bypass was performed on 50 lean rats as part of a study aimed at investigating the effect of the procedure on the physiologic mechanisms of glucose homeostasis. During the study, we have progressively refined details of anatomic exposure, technical aspects of duodeno-jejunostomy and peri-operative care. We analysed the role of such refinements in improving operative time and post-operative mortality. We found that refinement of exposure methods of the gastro-duodenal junction aimed at minimizing tension on small visceral vasculature, technical aspects of duodeno-jejunal anastomosis and peri-operative management played a major role in improving the survival rate and operative time. Overall, an experimental model of duodenual-jejunal bypass was successfully reproduced. Based on this experience, we describe here what we believe are the most important technical tips to reduce the learning curve for the procedure.

scholarly journals Real-time assessment of learning curve for robot-assisted laparoscopic prostatectomy

2020 ◽  
Vol 102 (9) ◽  
pp. 717-725
Author(s):  
A Tamhankar ◽  
N Spencer ◽  
A Hampson ◽  
J Noel ◽  
O El-Taji ◽  
...  
Keyword(s):  
Learning Curve ◽  
Operative Time ◽  
Learning Curves ◽  
Perioperative Outcomes ◽  
Robot Assisted ◽  
Large Dataset ◽  
Laparoscopic Prostatectomy ◽  
Assessment Of Learning ◽  
Inflection Points ◽  
Estimated Blood Loss

Introduction The learning curves analysed to date for robot-assisted laparoscopic prostatectomy are based on arbitrary cut-offs of the total cases. Methods We analysed a large dataset of robot-assisted laparoscopic prostatectomies from a single centre between 2008 and 2019 for assessment of the learning curve for perioperative outcomes with respect to time and individual cases. Results A total of 1,406 patients were evaluated, with mean operative time 198.08 minutes and mean console time 161.05 minutes. A plot of operative time and console time showed an initial decline followed by a near-constant phase. The inflection points were detected at 1,398 days (308th case) for operative time and 1,470 days (324th case) for console time, with a declining trend of 8.83 minutes and 7.07 minutes, respectively, per quarter-year (p<0.001). Mean estimated blood loss showed a 70.04% reduction between the start (214.76ml) and end (64.35ml) (p<0.001). The complication rate did not vary with respect to time (p=0.188) or the number of procedures (p=0.354). There was insufficient evidence to claim that the number of operations (p=0.326), D’Amico classification (p=0.114 for intermediate versus low; p=0.158 for high versus low) or time (p=0.114) was associated with the odds of positive surgical margins. Conclusions It takes about 300 cases and nearly 4 years to standardise operative and console times, with a requirement of around 80 cases per annum for a single surgical team in the initial years to optimise the outcomes of robot-assisted laparoscopic prostatectomy.

Laparoscopic Pyloromyotomy: A Study of the Learning Curve

2017 ◽  
Vol 28 (03) ◽  
pp. 238-242 ◽  
Author(s):  
François Bastard ◽  
Pierre Meignan ◽  
Karim Braïk ◽  
Anne Le Touze ◽  
Thierry Villemagne ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Learning Curve ◽  
Operative Time ◽  
Hospital Length ◽  
Learning Curves ◽  
Hospital Length Of Stay ◽  
Minimally Invasive Surgical ◽  
Significant Difference ◽  
Laparoscopic Pyloromyotomy

Introduction Laparoscopic pyloromyotomy (LPM) is a minimally invasive surgical technique used in pyloric stenosis treatment. This technique is safe, effective, and does not show more complications than laparotomy. Nevertheless, this technique requires an acquisition period to be optimally applied. This study analyses the learning curve of LPM. Materials and Methods Seven surgeons were retrospectively evaluated on their 40 first LPM. Patient data were recorded, including peroperative data (operation length and complications) and postoperative recoveries (renutrition, vomiting, and complications). The learning curves were evaluated and each variable was compared with the different moments of the learning curve. Results The mean operative time is 25 ± 11 minutes. It significantly decreases with the learning curve (p < 0.01). Ten procedures were necessary to acquire the operative technics. However, postoperative complications with a necessary redo procedure appear after the 10th patient. There is no significant difference concerning long-term postoperative complications according to the learning curve and to surgeons. The best results are recorded after the 20th patients. Hospital length of stay also decreases significantly after the 10th procedure. The recorded postoperative vomiting is independent to the operative time as the ad libitum feedings recovery. Conclusion The learning curve of LPM is cut into three stages. Only 10 cases are needed to acquire the gesture. Complications appear after this acquirement period.

scholarly journals Learning Curve for Laparoscopic Repair of Pediatric Inguinal Hernia Using Percutaneous Internal Ring Suturing

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 294
Author(s):  
Zenon Pogorelić ◽  
Dario Huskić ◽  
Tin Čohadžić ◽  
Miro Jukić ◽  
Tomislav Šušnjar
Keyword(s):  
Inguinal Hernia ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Hernia Repair ◽  
Learning Curve ◽  
Operative Time ◽  
Learning Curves ◽  
The Other ◽  
Internal Ring ◽  
Significant Difference

Background: Percutaneous internal ring suturing (PIRS) is a simple and popular technique for the treatment of inguinal hernia in children. The aim of this study was to analyze the learning curves during implementation of PIRS in our department. Methods: A total of 318 pediatric patients underwent hernia repair using the PIRS technique by three pediatric surgeons with different levels of experience in laparoscopic surgery. These patients were enrolled in a prospective cohort study during the period October 2015–January 2021. Surgical times, intraoperative and postoperative complications, in addition to outcomes of treatment were compared among the pediatric surgeons. Results: Regarding operative time a significant difference among the surgeons was found. Operative time significantly decreased after 25–30 procedures per surgeon. The surgeon with advanced experience in laparoscopic surgery had significantly less operative times for both unilateral (12 (interquartile range, IQR 10.5, 16.5) min vs. 21 (IQR 16.5, 28) min and 25 (IQR 21.5, 30) min; p = 0.002) and bilateral (19 (IQR 14, 21) min vs. 28 (IQR 25, 33) min and 31 (IQR 24, 36) min; p = 0.0001) hernia repair, compared to the other two surgeons. Perioperative complications, conversion, and ipsilateral recurrence rates were higher at the beginning, reaching the benchmarks when each surgeon performed at least 30 PIRS procedures. The most experienced surgeon had the lowest number of complications (1.4%) and needed a fewer number of cases to reach the plateau. The other two surgeons with less experience in laparoscopic surgery had higher rates of complications (4.4% and 5.4%) and needed a higher number of cases to reach the plateau (p = 0.190). Conclusions: A PIRS learning curve for perioperative and postoperative complications, recurrences, and conversion rates reached the plateau after each surgeon had performed at least 30 cases. After that number of cases PIRS is a safe and effective approach for pediatric hernia repair. A surgeon with an advanced level of experience in pediatric laparoscopic surgery adopted the technique more easily and had a significantly faster learning curve.

scholarly journals Learning curves in robot-assisted spine surgery: a systematic review and proposal of application to residency curricula

2022 ◽  
Vol 52 (1) ◽  
pp. E3
Keyword(s):  
Systematic Review ◽  
Learning Curve ◽  
English Language ◽  
Operative Time ◽  
Case Series ◽  
Clinical Results ◽  
Learning Curves ◽  
Primary Data ◽  
Qualitative Synthesis ◽  
Half Decade

OBJECTIVE Spine robots have seen increased utilization over the past half decade with the introduction of multiple new systems. Market research expects this expansion to continue over the next half decade at an annual rate of 20%. However, because of the novelty of these devices, there is limited literature on their learning curves and how they should be integrated into residency curricula. With the present review, the authors aimed to address these two points. METHODS A systematic review of the published English-language literature on PubMed, Ovid, Scopus, and Web of Science was conducted to identify studies describing the learning curve in spine robotics. Included articles described clinical results in patients using one of the following endpoints: operative time, screw placement time, fluoroscopy usage, and instrumentation accuracy. Systems examined included the Mazor series, the ExcelsiusGPS, and the TiRobot. Learning curves were reported in a qualitative synthesis, given as the mean improvement in the endpoint per case performed or screw placed where possible. All studies were level IV case series with a high risk of reporting bias. RESULTS Of 1579 unique articles, 97 underwent full-text review and 21 met the inclusion and exclusion criteria; 62 articles were excluded for not presenting primary data for one of the above-described endpoints. Of the 21 articles, 18 noted the presence of a learning curve in spine robots, which ranged from 3 to 30 cases or 15 to 62 screws. Only 12 articles performed regressions of one of the endpoints (most commonly operative time) as a function of screws placed or cases performed. Among these, increasing experience was associated with a 0.24- to 4.6-minute decrease in operative time per case performed. All but one series described the experience of attending surgeons, not residents. CONCLUSIONS Most studies of learning curves with spine robots have found them to be present, with the most common threshold being 20 to 30 cases performed. Unfortunately, all available evidence is level IV data, limited to case series. Given the ability of residency to allow trainees to safely perform these cases under the supervision of experienced senior surgeons, it is argued that a curriculum should be developed for senior-level residents specializing in spine comprising a minimum of 30 performed cases.

A Single Surgeon’s 10-Year Experience in Remote-Access Thyroid and Parathyroid Surgery

2020 ◽  
pp. 000313482095030
Author(s):  
Emad Kandil ◽  
Mounika Akkera ◽  
Hosam Shalaby ◽  
Ruhul Munshi ◽  
Abdallah Attia ◽  
...  
Keyword(s):  
Learning Curve ◽  
Evoked Potential ◽  
Operative Time ◽  
Endoscopic Thyroidectomy ◽  
Remote Access ◽  
Parathyroid Surgery ◽  
American Institute ◽  
Effective Learning ◽  
Select Group ◽  
Vestibular Approach

Background Remote-access thyroid and parathyroid surgery has gained popularity recently due to its benefit of avoiding visible neck scars. Most of these techniques were described and performed in Asia, on patients with different body habitus compared to American patients. We aim to analyze the learning curve in performing these operations in North America.  Methods This is a retrospective cohort study of a 10-year experience by a single surgeon at a North American institute. Patients who underwent thyroid or parathyroid procedures by a transaxillary, retroauricular, or transoral endoscopic thyroidectomy vestibular approach (TOETVA) were included. Cumulative sum (CUSUM) was used to analyze learning curves based on intraoperative blood loss and total operative times and learning phases were divided accordingly. Results Three hundred seventy-two remote-access thyroid and parathyroid procedures were performed during the study period. Total operative time for transaxillary procedures was initially reduced after the 69th procedure and then again after the 134th case. For retroauricular procedures, marked reduction in the operative time was observed after 21 procedures. Most patients (57.02%) were discharged home on the same day during the mastering phase. In the transaxillary procedures, only 1 case of brachial plexus injury occurred prior to the routine use of somatosensory evoked potential (SSEP) monitoring. Discussion Remote-access thyroid and parathyroid surgeries can be performed safely with minimal complications in a select group of patients. Analysis of the learning curve in performing these operations aids in structuring a safe and effective learning period for endocrine surgeons seeking to venture into this modality of treatment.

Sign in / Sign up

Export Citation Format

Share Document