Learning curve for robot-assisted Ivor Lewis esophagectomy

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.

125 Staged Endovascular Treatment of Ruptured Intracranial Aneurysms: Acute Coiling Followed By Delayed Flow Diversion

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 228-228
Author(s):  
Erick Michael Westbroek ◽  
Matthew Bender ◽  
Narlin B Beaty ◽  
Bowen Jiang ◽  
Risheng Xu AB ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Complication Rate ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Major Complication ◽  
Flow Diversion ◽  
Neurological Deficits ◽  
Major Complication Rate ◽  
Ruptured Intracranial Aneurysms

Abstract INTRODUCTION ISAT demonstrated that coiling is effective for aneurysm treatment in subarachnoid hemorrhage (SAH); however, complete occlusion of wide-necked aneurysms frequently requires adjuvants relatively contraindicated in SAH. As such, a limited “dome occlusive” strategy is often pursued in the setting of SAH. We report a single institution series of coiling of acutely ruptured aneurysms followed by delayed flow diversion for definitive, curative occlusion. METHODS A prospectively collected IRB-approved database was screened for patients with aneurysmal SAH who were initially treated by coil embolization followed by planned flow diversion at a single academic medical institution. Peri-procedural outcomes, complications, and angiographic follow-up were analyzed. RESULTS >50 patients underwent both acute coiling followed by delayed, planned flow diversion. Average aneurysm size on initial presentation was 9.5 mm. Common aneurysm locations included Pcomm (36%), Acomm (30%), MCA (10%), ACA (10%), and vertebral (5%). Dome occlusion was achieved in all cases following initial coiling. Second-stage implantation of a flow diverting stent was achieved in 49/50 cases (98%). Follow-up angiography was available for 33/50 patients (66%), with mean follow-up of 11 months. 27 patients (82%) had complete angiographic occlusion at last follow up. All patients with residual filling at follow-up still had dome occlusion. There were no mortalities (0%). Major complication rate for stage I coiling was 2% (1 patient with intra-procedural aneurysm re-rupture causing increase in a previous ICH). Major complication rate for stage 2 flow diversion was 2% (1 patient with ischemic stroke following noncompliance with dual antiplatelet regimen). Minor complications occurred in 2 additional patients (4%) with transient neurological deficits. CONCLUSION Staged endovascular treatment of ruptured intracranial aneurysms with acute dome-occlusive coil embolization followed by delayed flow diversion is a safe and effective treatment strategy.

Diagnostic accuracy and complication rate of image-guided percutaneous transthoracic needle lung biopsy for subsolid pulmonary nodules: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Junghoon Kim ◽  
Choong Guen Chee ◽  
Jungheum Cho ◽  
Youngjune Kim ◽  
Min A Yoon
Keyword(s):  
Diagnostic Accuracy ◽  
Complication Rate ◽  
Needle Biopsy ◽  
Meta Analysis ◽  
Pulmonary Nodules ◽  
Major Complication ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Major Complication Rate ◽  
Higher Sensitivity

Objectives: To determine the diagnostic accuracy and complication rate of percutaneous transthoracic needle biopsy (PTNB) for subsolid pulmonary nodules and sources of heterogeneity among reported results. Methods: We searched PubMed, EMBASE, and Cochrane libraries (until November 7, 2020) for studies measuring the diagnostic accuracy of PTNB for subsolid pulmonary nodules. Pooled sensitivity and specificity of PTNB were calculated using a bivariate random-effects model. Bivariate meta-regression analyses were performed to identify sources of heterogeneity. Pooled overall and major complication rates were calculated. Results: We included 744 biopsies from 685 patients (12 studies). The pooled sensitivity and specificity of PTNB for subsolid nodules were 90% (95% confidence interval [CI]: 85–94%) and 99% (95% CI: 92–100%), respectively. Mean age above 65 years was the only covariate significantly associated with higher sensitivity (93% vs  85%, p = 0.04). Core needle biopsy showed marginally higher sensitivity than fine-needle aspiration (93% vs  83%, p = 0.07). Pooled overall and major complication rate of PTNB were 43% (95% CI: 25–62%) and 0.1% (95% CI: 0–0.4%), respectively. Major complication rate was not different between fine-needle aspiration and core needle biopsy groups (p = 0.25). Conclusion: PTNB had acceptable performance and a low major complication rate in diagnosing subsolid pulmonary nodules. The only significant source of heterogeneity in reported sensitivities was a mean age above 65 years. Advances in knowledge: This is the first meta-analysis attempting to systemically determine the cause of heterogeneity in the diagnostic accuracy and complication rate of PTNB for subsolid pulmonary nodules.

scholarly journals Fixation of Ankle Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0008
Author(s):  
Andrew Molloy ◽  
Samantha Whitehouse ◽  
Lyndon Mason
Keyword(s):  
Complication Rate ◽  
Major Complication ◽  
Ankle Fractures ◽  
Complication Rates ◽  
Junior Staff ◽  
System Changes ◽  
Major Complication Rate ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Category: Trauma Introduction/Purpose: Ankle fractures are one of the most common fractures. Historically these have been frequently treated by non-specialists and junior staff. In 2011 we presented high malunion rates, which have been mirrored in other departments work. We present the results of system changes to improve the results of ankle fracture fixation Methods: Image intensifier films were reviewed on PACS and scored based on the criteria published by Pettrone et al. At least two blinded assessors assigned scores independently. Patients clinical data was collected from medical records. In 2011 we presented the results of fixation in 94 consecutive patients (Group 1) from 2009. Following this there was period of education in the department to allow change. 68 patients (Group 2) were then reviewed from a 7 month period in 2014 Multiple system changes were introduced in the department including; new treatment algorithms, dedicated foot and ankle trauma lists and clinics, and next day review of all intra-operative radiographs by independent attending. Prospective data was collected on 205 consecutive cases (Group 3) from 01/01/15 – 09/30/16 Results: Patients in group 1 had a malreduction rate of 33%. The major complication rate in this group was 8.5% (8 patients); with only one of these occurred in a correctly reduced fracture. These complications included 4 revision fixations, 2 deep infections and 1 amputation. Following the period of re-education, in Group 2, the mal-reduction rate deteriorated to 43.8%. In this group the major complication rate was 10.9%; including 6 revision fixations and 1 ankle fusion. In Group 3, following overall system changes, the malreduction rate was 2.4%. This result is statistically significant. The major complication rate fell to 0.98%; 1deep infection and 1 amputation (in a polytrauma patient with vascular injury). This result is again statistically significant. Conclusion: Our initial results show that very poor results are a consequence when sufficient attention is not given to what are frequently considered to be ‘simple’ fractures. In group 2 we demonstrated that soft educational changes (eg presentations, emails) are ineffective in improving results. We have demonstrated that hard (institutional system) changes in our department provided statistically significant improvements. These changes allowed the correct surgeon for the fracture in both determining the treatment plan and operating. With these changes, malreduction rates fell from 43.8% to 2.4% and major complication rates from 10.9% to 0.98%

Factors contributing to the success and major complication rate of ultrasound-guided native kidney biopsies

2014 ◽  
Vol 25 (3) ◽  
pp. S117-S118
Author(s):  
J. Kriegshauser ◽  
M.D. Patel ◽  
S.W. Young ◽  
F. Chen ◽  
W.G. Eversman ◽  
...  
Keyword(s):  
Complication Rate ◽  
Major Complication ◽  
Ultrasound Guided ◽  
Native Kidney ◽  
Major Complication Rate

scholarly journals Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 231
Author(s):  
Ponco Birowo ◽  
William Tendi ◽  
Indah S. Widyahening ◽  
Nur Rasyid ◽  
Widi Atmoko
Keyword(s):  
Hospital Stay ◽  
Prone Position ◽  
Percutaneous Nephrolithotomy ◽  
Complication Rate ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Major Complication ◽  
Stone Free Rate ◽  
Major Complication Rate ◽  
Free Rate

Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 – 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 – 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon’s experience and clinical aspects of the patients.

scholarly journals Outcome of robot-assisted pancreaticoduodenectomy during initial learning curve versus laparotomy

2019 ◽  
Author(s):  
Jiangjiao Zhou ◽  
Heng Zou ◽  
Li Xiong ◽  
Xiongying Miao ◽  
Zhongtao Liu ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Learning Curve ◽  
Operative Time ◽  
Operation Time ◽  
Robot Assisted ◽  
Extensive Experience ◽  
Curve Versus ◽  
Initial Learning ◽  
Cusum Method ◽  
Open Pancreaticoduodenectomy

Abstract Background : To analyze the initial learning curve (LC) for robot-assisted pancreaticoduodenectomy (RAPD) and compare RAPD during the initial LC with open pancreaticoduodenectomy (OPD) in terms of outcome. Methods : This study is a retrospective review of patients who consecutively underwent RAPD between October 2015 and May 2019 in our hospital. Experiences from 30 initial consecutive RAPD cases, considered the initial LC of a single surgeon team, were compared with those from laparotomy cases during the same period in terms of outcome. Preoperative demographic and comorbidity data were obtained. Perioperative data on operation time, blood transfusion, numbers of harvested lymph nodes, 90-day mortality and readmission, surgery-related complications, postoperative hospital stay, and total costs were acquired for analysis. The operation time for RAPD was evaluated using the cumulative sum(CUSUM) method. Results : Seventy-eight patients, including 30 consecutive RAPD cases and 48 consecutive open cases, were enrolled for review. The demographic and comorbidity characteristics of the two groups were similar. Compared with OPD, RAPD required a significantly longer operative time (423.67 ± 137.627 min vs. 228.75 ± 44.988 min, P < 0.001) and higher cost (185700 ± 54500 RMB vs. 120600 ± 41700 RMB, P < 0.001). Moreover, compared with the OPD group, the RAPD group revealed a significantly smaller mean number of lymph nodes harvested in malignant cases (8.72 ± 4.9 vs 14.26 ± 7.633, P = 0.007). No statistically significant differences were observed between the two groups in terms of incidence of Clavien–Dindo grade III–V morbidities and 90-day mortality and readmission. In the CUSUM graph, one peak point was observed at the 8th case, after which the operation time began to decrease. Conclusions : RAPD is safe when performed in well-selected patients by well-trained teams with extensive experience in open pancreaticoduodenectomy during the initial LC,and the LC of RAPD may be shorten less than 30 cases.

scholarly journals The learning curve for ultrasound-guided peripheral intravenous cannulation in adults: a multicenter study

2022 ◽  
Author(s):  
Fredericus HJ Van Loon ◽  
Harm J Scholten ◽  
Hendrikus HM Korsten ◽  
Angelique TM Dierick - van Daele ◽  
Arthur RA Bouwman
Keyword(s):  
Learning Curve ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Training Session ◽  
Hands On ◽  
Individual Participant ◽  
Cusum Analysis ◽  
Multicenter Prospective Observational Study ◽  
Two Phases ◽  
Cannulation Success

Aims: To lower the threshold for applying ultrasound (US) guidance during peripheral intravenous cannulation, nurses need to be trained and gain experience in using this technique. The primary outcome was to quantify the number of procedures novices require to perform before competency in US-guided peripheral intravenous cannulation was achieved. Materials and methods: A multicenter prospective observational study, divided into two phases after a theoretical training session: a hands-on training session and a supervised life-case training session. The number of US-guided peripheral intravenous cannulations a participant needed to perform in the life-case setting to become competent was the outcome of interest. Cusum analysis was used to determine the learning curve of each individual participant. Results: Forty-nine practitioners participated and performed 1855 procedures. First attempt cannulation success was 73% during the first procedure, but increased to 98% on the fortieth attempt (p<0.001). The overall first attempt success rate during this study was 93%. The cusum learning curve for each practitioner showed that a mean number of 34 procedures was required to achieve competency. Time needed to perform a procedure successfully decreased when more experience was achieved by the practitioner, from 14±3 minutes on first proce-dure to 3±1 minutes during the fortieth procedure (p<0.001). Conclusions: Competency in US-guided peripheral intravenous cannulation can be gained after following a fixed educational curriculum, resulting in an increased first attempt cannulation success as the number of performed procedures increased.

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