scholarly journals From McKeown to Ivor Lewis, the learning curve for thoracic lymphadenectomy over the first 100 robotic esophagectomy cases: a retrospective study

2021 ◽  
Vol 13 (3) ◽  
pp. 1543-1552
Author(s):  
Ze-Guo Zhuo ◽  
Gang Li ◽  
Tie-Niu Song ◽  
Gu-Ha Alai ◽  
Xu Shen ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Learning Curve ◽  
Ivor Lewis ◽  
Robotic Esophagectomy

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.

Robotic Esophagectomy: Ivor Lewis

2021 ◽  
pp. 125-140
Author(s):  
Peter P. Grimminger ◽  
Giovanni Capovilla ◽  
Evangelos Tagkalos
Keyword(s):  
Ivor Lewis ◽  
Robotic Esophagectomy

scholarly journals Laparoscopic management of appendicular lump

2020 ◽  
Vol 7 (9) ◽  
pp. 3065
Author(s):  
Manoj Kumar Chaudhary ◽  
Mrinal Shankar ◽  
Tridip Dutta Baruah ◽  
Rubik Ray ◽  
Shubham Samal
Keyword(s):  
Retrospective Study ◽  
Learning Curve ◽  
Treatment Cost ◽  
Operative Time ◽  
Site Infection ◽  
Early Recovery ◽  
Operative Complications ◽  
Average Operative Time ◽  
Laparoscopic Intervention ◽  
Time Of Admission

The surgical management of an appendicular lump remains controversial. With the revolution and advancement of laparoscopic instrumentation and technical learning curve, it is possible to remove an inflamed appendix in presence of lump. This retrospective study was performed between August 2018 and August 2019 in AIIMS Raipur, 86 patients were treated for appendicitis laparoscopically, in these 14 patients had appendicular lump at the time of admission. 12 patients (total 14; 2 patients were excluded) underwent laparoscopic intervention for appendicular lump. Average operative time were 90 minutes. Average post-operative hospital stay were 5 days. Post-operative complications were seen in 2 patients (surgical site infection). In histopathology report, appendicular inflammation suggestive of appendicitis were present in all operated cases. We conclude, early laparoscopic appendectomy confirms the diagnosis. It is safe and feasible in patients with appendicular lump. It reduces the treatment cost, early recovery and satisfactory overall outcome.

Redefining the learning curve for robotic esophagectomy.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 132-132
Author(s):  
Ken Lee Meredith ◽  
Jamie Huston ◽  
Pedro Briceno ◽  
Ravi Shridhar
Keyword(s):  
Minimally Invasive ◽  
Learning Curve ◽  
Minimally Invasive Esophagectomy ◽  
Neoadjuvant Chemoradiation ◽  
Esophageal Disease ◽  
Robotic Assisted ◽  
Invasive Esophagectomy ◽  
Robotic Esophagectomy ◽  
Conversion Rates ◽  
Morbidity Index

132 Background: Minimally invasive esophagectomy(MIE) has demonstrated superior outcomes compared to open approaches. The myriad of techniques has precluded the recommendation of a standard approach. The robotic approach has increased steadily. We have previously published our series defining the learning curve for this approach. The purpose of this study is to redefine the learning curve for robotic-assisted esophagogastrectomy with respect to operative time, conversion rates, and patient safety. Methods: We have prospectively followed all patients undergoing robotic-assisted esophagogastrectomy and compared operations performed at our institutions by a single surgeon in successive cohorts. Our measures of proficiency included: operative times, conversion rates, and complications. Statistical analyses were undertaken utilizing Spearman regression analysis and Mann-Whitney U test. Significance was accepted with 95 % confidence. Results: We identified 203 patients (166 [81.8%] male: 37 [18.2%] female) of median age of 67.2 (30-90) years who underwent robotic-assisted esophagogastrectomies for malignant esophageal disease. One-hundred sixty six were adenocarcinoma, 26 were squamous cell carcinoma and 11 were other. R0 resections was performed in 202 (99.5%) of patients. The median lymph node harvest was 18 (6-63). Neoadjuvant chemoradiation was administered to 157 (77.4%) patients. A significant reduction in operative times (p <0.005) following completion of 20 procedures was identified (514 ± 106 min vs. 415± 91 min compared to subsequent 80 cases and further reduced with the subsequent 100 cases 397 ± 71.9 min) p<0.001. Complications decreased after the initial learning curve of 29 cases, p=0.04. However there was an increase in complications after 90 cases in which there was an increase in the Charleson morbidity index, p<0.01 indicating higher risk patients which tapered after case 115. Conclusions: For surgeons proficient in performing minimally-invasive esophagogastrectomies, the learning curve for a robotic-assisted procedure appears to begin near proficiency after 20 cases however as more complex cases are undertake there appears to be an additional learning curve which is surpassed after 90 cases.

scholarly journals Robotic esophagectomy: ivor-lewis approach

2021 ◽  
Vol 5 ◽  
pp. 12-12
Author(s):  
Ghulam Abbas
Keyword(s):  
Ivor Lewis ◽  
Robotic Esophagectomy
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