scholarly journals Learning Curve for Open Reduction and Internal Fixation of Displaced Intra-Articular Calcaneal Fracture by Extensile Lateral Approach Using the Cumulative Summation Control Chart

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0008
Author(s):  
Jungtae Ahn ◽  
Tae Yong Kim ◽  
Tae Wook Kim ◽  
Bi O Jeong
Keyword(s):  
Learning Curve ◽  
Moving Average ◽  
Operating Time ◽  
Calcaneal Fracture ◽  
Lateral Approach ◽  
Phase 2 ◽  
Extensile Lateral Approach ◽  
Cumulative Summation ◽  
The Mean

Category: Trauma Introduction/Purpose: Open reduction and internal fixation (ORIF) of displaced intra-articular calcaneal fracture (DIACF) by extensile lateral approach is widely used but is technically challenging. In this study, the learning curve for ORIF of DIACF by extensile lateral approach was investigated. Methods: Between March 2014 and July 2018, 45 cases consisting of 40 patients underwent operative treatment for DIACF by the extensile lateral approach performed in all instances by a single surgeon. A moving average and cumulative summation control chart (CUSUM) were used for learning curve analyses. Operative failure was defined when at least one of the following parameters were unsatisfactory: reduction of Gissane angle and Böhler angle, posterior facet congruency, calcaneal width, subfibular impingement, axial alignment, or calcaneocuboid joint congruency. Results: The mean operating time was 117.4 min. Regarding the quality of reduction, the mean preoperative sum of the 7 parameters was 5.1 and improved to 0.6 postoperatively. The CUSUM for operative success peaked in the 20th case. The CUSUM and moving average graphics of operating time peaked at the 9th case and registered nadirs at the 34th case, with slight ascent and decent. The operating time for twenty cases in phase 1 (1–20) and for twenty-five cases in phase 2 (21–45) of the learning curve did not differ significantly. There was no statistical difference in the severity of fracture pattern. By comparison, significant differences in phase 2 patients showed a better postoperative reduction quality. Conclusion: As indicated by multidimensional statistical analyses, primary technical competence in improving the reduction quality of DIACF was achieved after the initial learning period with 20 cases. After the learning curve for ORIF of DIACF, a better reduction quality in the sum of reduction parameters was observed.

Learning Curve for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fracture by Extensile Lateral Approach Using the Cumulative Summation Control Chart

2019 ◽  
Vol 40 (9) ◽  
pp. 1052-1059 ◽  
Author(s):  
Jungtae Ahn ◽  
Tae Yong Kim ◽  
Tae Wook Kim ◽  
Bi O Jeong
Keyword(s):  
Learning Curve ◽  
Moving Average ◽  
Operating Time ◽  
Calcaneal Fracture ◽  
Lateral Approach ◽  
Phase 2 ◽  
Extensile Lateral Approach ◽  
Cumulative Summation ◽  
The Mean

Background: Open reduction and internal fixation (ORIF) of displaced intra-articular calcaneal fracture (DIACF) by extensile lateral approach is widely used but is technically challenging. In this study, the learning curve for ORIF of DIACF by extensile lateral approach was investigated. Methods: Between March 2014 and July 2018, 45 cases consisting of 40 patients underwent operative treatment for DIACF by the extensile lateral approach performed in all instances by a single surgeon. A moving average and cumulative summation control chart (CUSUM) were used for learning curve analyses. Operative failure was defined when at least 1 of the following parameters were unsatisfactory: reduction of Gissane angle and Böhler angle, posterior facet congruency, calcaneal width, subfibular impingement, axial alignment, or calcaneocuboid joint congruency. Results: The mean operating time was 117.4 minutes. Regarding the quality of reduction, the mean preoperative sum of the 7 parameters was 5.1 and improved to 0.6 postoperatively. The CUSUM for operative success peaked in the 20th case. The CUSUM and moving average graphics of operating time peaked at the 9th case and registered nadirs at the 34th case, with slight ascent and decent. The operating time for 20 cases in phase 1 (1-20) and for 25 cases in phase 2 (21-45) of the learning curve did not differ significantly. There was no statistical difference in the severity of fracture pattern. By comparison, in phase 2, patients showed a significantly better postoperative reduction quality. Conclusion: As indicated by multidimensional statistical analyses, primary technical competence in improving the reduction quality of DIACF was achieved after the initial learning period with 20 cases. After the learning curve for ORIF of DIACF, a better reduction quality in the sum of reduction parameters was observed. Level of Evidence: Level III, comparative series.

scholarly journals Sinus tarsi approach vs. extensile lateral approach for intra-articular calcaneal fracture

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0028
Author(s):  
Methee Khongphaophong
Keyword(s):  
Hospital Stay ◽  
Open Reduction ◽  
Operative Time ◽  
Locking Plate ◽  
Calcaneal Fracture ◽  
Lateral Approach ◽  
Wound Complications ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Extensile Lateral Approach

Category: Trauma Introduction/Purpose: The options of operative treatment for intra-articular calcaneal fracture still remains controversial. Extensile lateral approach allow excellent exposure to fracture, but bring high rate of wound complications. The aim of this study was to compare the outcome of intra-articular calcaneal fracture treated with open reduction and internal fixation via an extensile lateral versus. Sinus tarsi approach Methods: Prospective study of 62 intra-articular calcaneal fractures treated by open reduction and internal fixation between 2014, October to 2017, June. 29 were treated with extensile lateral approach with calcaneal locking plate(Wright medical, Tennessee), 33 sinus tarsi approach(4 cases need additional mini medial incision approaches for SanderIII AC, BC) with mini-calcaneal locking plate(Normed, Florida). Durations until operation, operative time, foot functional index(total score), visual analog scale, SF-36, Bohler’s angle, angle of Gissane, wound complications and duration of hospital stay were recorded post-operatively and minimal 6 months follow up. Results: Compared 2 groups with demographic datas.Average duration until operation; extensile group was 13.32 days, sinus tarsi group was 6.08 days, p <0.001. Operative time; extensile group was 123.41minutes vs. sinus tarsi group was 91.20 minutes, p <0.001. Wound complications was 24.13% in extensile group vs. 6.06% in sinus tarsi group, p =0.045, Duration of post-operative admission was 6.68 days in extensile group vs. 3.10 days in sinus tarsi group p <0.001 FFI last visits was 25.36 in extensile group vs. 25.65 in sinus tarsi group, p =0.969, VAS activity was 29.68 in extensile group vs. 28.54 in sinus tarsi group, p=0.271. Conclusion: Sinus tarsi approach with mini-calcaneal locking plate was a great option for treatment of intra-articular calcaneal fracture. This approach brought lower rate of wound complications, earlier operations, shorter operation times and shorter hospital stay compared to extensile lateral approach.

Quality of Reduction of Displaced Intra-Articular Calcaneal Fractures Using a Sinus Tarsi versus Extensile Lateral Approach

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Gennadiy Busel ◽  
Hassan R. Mir ◽  
Stephanie Merimee ◽  
Raahil Patel ◽  
Omar Atassi ◽  
...  
Keyword(s):  
Lateral Approach ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Extensile Lateral Approach

scholarly journals P-OGC81 The learning curve for robotic assisted abdominal phase in two stage oesophagectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Patrick McQuillan ◽  
Salman Ahmed ◽  
Mazair Navidi ◽  
Shajahan Wahed ◽  
Arul Immanual
Keyword(s):  
Learning Curve ◽  
Operating Time ◽  
Open Group ◽  
R0 Resection ◽  
Two Stage ◽  
Nodal Count ◽  
Robotic Assisted ◽  
Significant Difference ◽  
Phase Group ◽  
The Mean

Abstract Background Robotic assisted oesophagectomy (RAO) is increasingly being utilised in the management of oesophageal cancer. RAO implementation into practice has an inevitable learning curve. As oesophagectomy usually involves at least 2 stages, a staggered approach to training and introduction of RAO can be done. A major advantage of this is that the surgeon can concentrate on overcoming the learning curve in one phase of the procedure at a time, whilst the remaining phase can be completed by an established technique. This study looks at the learning curve of a robotic assisted abdominal phase for two-stage oesophagectomy compared to an open abdominal phase to achieve parity. Methods This study uses a prospectively maintained database to retrospectively analyse the abdominal phase of the first 17 RAO compared to the previous 20 open abdominal phase procedures. The cases are sequential, done by a single surgeon at a large UK oesophagogastric referral centre. Operating time, nodal count, and R0 rate were reviewed to determine the number of cases on the learning curve to reach parity with the open procedure. Results The open abdominal phase group had a similar age (65.6 vs 65.7), pre-op anaerobic threshold (13.9 vs 14.6 p = 0.3) but a higher BMI (mean 30.6 vs 24.6 p &lt; 0.05) then the RAO group. All cases were T3 adenocarcinoma except for 2 cases in the robotic group (one HGD and one T2 adenocarcinoma). No RAO cases were converted to open. The mean time for the abdominal phase in the open group was 175.4 minutes with an average nodal count of 32.9. After 8 robotic assisted cases the mean operating time decreased from 267 minutes to 197 minutes, which was when a non-significant difference to the open group (p = 0.094) became apparent. The mean nodal count in the first 8 robotic assisted cases was 29.5 and increased to 38.4 in the subsequent cases. All patients had a R0 resection. Conclusions The multi-phase nature of oesophagectomy allows for modular implementation of a robotic programme. We have found that the learning curve for robotic assisted abdominal is around 8 cases. This allows for parity to open abdominal phase to be achieved regarding operative time, nodal count and R0 resection.

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.

Learning Curve in Laparoscopic Living Donor Nephrectomy

2018 ◽  
Vol 24 (8) ◽  
pp. 6190-6193
Author(s):  
K. E Sidabutar ◽  
A. R Hamid ◽  
I Wahyudi ◽  
C. A Mochtar
Keyword(s):  
Learning Curve ◽  
Living Donor ◽  
Operating Time ◽  
High Volume ◽  
Training Programme ◽  
Donor Nephrectomy ◽  
Living Donor Nephrectomy ◽  
The Mean ◽  
Group 2 ◽  
Group 1

To examine the learning curve of laparoscopic living donor nephrectomy (LLDN) in our institution. A retrospective review was performed for the initial 300 cases of laparoscopic living donor nephrectomy in Cipto Mangunkusumo Hospital from November 2011 to December 2015. The data was classified into three groups of 100 procedures. In the initial cases, the procedure was performed by one laparoscopic surgeon. After a series of cases, another laparoscopic surgeon began performing donor nephrectomy, followed by a third laparoscopic surgeon. Each procedure was performed by two laparoscopic surgeon. We evaluated 300 patients of laparoscopic living donor nephrectomy in our center and compared each group. The mean total operating time showed a significant decline in group 3 compared to group 1 (261.6±49 minutes vs. 239.7±36.4 minutes) (p = 0.001). The mean time to clip presented a decline in group 2 and 3 (172.5±44.1 minutes vs. 160.3±31.8 minutes vs. 146.4±34.7 minutes) (p < 0.05). The mean first warm ischemia times dropped from 6.3±3.6 minutes to 2.9±1.9 minutes to 2.0±0.6 minutes (p < 0.05). The median estimated intraoperative blood loss fell from 200 cc in group 1 to 100 cc in group 2 and 3 (p < 0.001). High volume of cases and direct mentoring system enhance the learning curve in LLDN procedure which was categorized as a very difficult procedure. The development of a successful laparoscopic live donor nephrectomy training programme can be achieved without significant detrimental effect to the patient provided the necessary steps are observed.

scholarly journals Endoscope-assisted (with robotic guidance and using a hybrid technique) interhemispheric transcallosal hemispherotomy: a comparative study with open hemispherotomy to evaluate efficacy, complications, and outcome

2019 ◽  
Vol 23 (2) ◽  
pp. 187-197 ◽  
Author(s):  
P. Sarat Chandra ◽  
Heri Subianto ◽  
Jitin Bajaj ◽  
Shabari Girishan ◽  
Ramesh Doddamani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Loss ◽  
Hospital Stay ◽  
Primary Outcome ◽  
Operating Time ◽  
First Episode ◽  
Hybrid Technique ◽  
The Mean ◽  
Secondary Outcomes

OBJECTIVEEndoscope-assisted hemispherotomy (EH) has emerged as a good alternative option for hemispheric pathologies with drug-resistant epilepsy.METHODSThis was a prospective observational study. Parameters measured included primary outcome measures (frequency, severity of seizures) and secondary outcomes (cognition, behavior, and quality of life). Blood loss, operating time, complications, and hospital stay were also taken into account. A comparison was made between the open hemispherotomy (OH) and endoscopic techniques performed by the senior author.RESULTSOf 59 cases (42 males), 27 underwent OH (8 periinsular, the rest vertical) and 32 received EH. The mean age was 8.65 ± 5.41 years (EH: 8.6 ± 5.3 years; OH: 8.6 ± 5.7 years). Seizure frequency per day was 7 ± 5.9 (EH: 7.3 ± 4.6; OH: 15.0 ± 6.2). Duration of disease (years since first episode) was 3.92 ± 1.24 years (EH: 5.2 ± 4.3; OH: 5.8 ± 4.5 years). Number of antiepileptic drugs per patient was 3.9 ± 1.2 (EH: 4.2 ± 1.2; OH: 3.8 ± 0.98). Values for the foregoing variables are expressed as the mean ± SD. Pathologies included the following: postinfarct encephalomalacia in 19 (EH: 11); Rasmussen’s syndrome in 14 (EH: 7); hemimegalencephaly in 12 (EH: 7); hemispheric cortical dysplasia in 7 (EH: 4); postencephalitis sequelae in 6 (EH: 2); and Sturge-Weber syndrome in 1 (EH: 1). The mean follow-up was 40.16 ± 17.3 months. Thirty-nine of 49 (79.6%) had favorable outcomes (International League Against Epilepsy class I and II): in EH the total was 19/23 (82.6%) and in OH it was 20/26 (76.9%). There was no difference in the primary outcome between EH and OH (p = 0.15). Significant improvement was seen in the behavioral/quality of life performance, but not in IQ scores in both EH and OH (p < 0.01, no intergroup difference). Blood loss (p = 0.02) and hospital stay (p = 0.049) were less in EH.CONCLUSIONSEH was as effective as the open procedure in terms of primary and secondary outcomes. It also resulted in less blood loss and a shorter postoperative hospital stay.

scholarly journals Short term outcome of total knee replacement in Kashmiri population without co-morbidities

2019 ◽  
Vol 6 (8) ◽  
pp. 2921
Author(s):  
M. Ahsan Wani ◽  
Mushtaq Ahmed Ganaiee ◽  
Bashir Ahmed Mir ◽  
Asif Sultan ◽  
Muneebul Islam
Keyword(s):  
Quality Of Life ◽  
Total Knee Replacement ◽  
Range Of Motion ◽  
Knee Replacement ◽  
Pain Perception ◽  
Operating Time ◽  
Term Outcome ◽  
Total Knee ◽  
The Mean

Background: The aim of the study was to evaluate the patients of osteoarthritis of knee prior to surgery and then 6 weeks after the total knee replacement surgery with regards pain, range of motion, stability, deformity, quadriceps power and support.Methods: This is a prospective follow up study. A minimum of 20 patients have been included in this study conducted in Department of Orthopedics, Bone and Joint Hospital Barzullah Srinagar, during the period of September 2014 to November 2016.Results: The average age of patients was 59.63 years, more than 35% of the patients belonged to the age group 66-70 years, majority of the patients were females (70%) in the whole study group. Most (88.89%) cases were bilateral, affecting both knees. The mean pre-operative range of motion in 94.38 degrees. The mean postoperative range of motion was 113.75 degrees. Patients were followed up at 2, 4, 6 weeks postoperatively. The average blood loss was 500 ml and the average operating time was one hour and 15 minutes and one hour. There was one deep vein thrombosis, one delayed wound healing, one common peroneal nerve palsy and one valgus deformity.Conclusions: The patients with  more severely deformed knees, are more elderly, have more pain perception, their functional quality of life was   impaired more, they were physically more dependent and their quality of life improves significantly after surgery.

Sign in / Sign up

Export Citation Format

Share Document