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

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jiangjiao Zhou ◽  
Li Xiong ◽  
Xiongying Miao ◽  
Juan Liu ◽  
Heng Zou ◽  
...  
Keyword(s):  
Learning Curve ◽  
Robot Assisted ◽  
Curve Versus ◽  
Initial Learning

Comparison of surgical and pathological parameters after laparoscopic transperitoneal pelvic/para-aortic lymphadenectomies

2020 ◽  
Vol 30 (11) ◽  
pp. 1798-1802
Author(s):  
Anna Jacob ◽  
Andrea Plaikner ◽  
Achim Schneider ◽  
Giovanni Favero ◽  
Roberto Tozzi ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Learning Curve ◽  
Operative Time ◽  
Period 2 ◽  
Initial Learning ◽  
Operative Complications ◽  
Node Count ◽  
Laparoscopic Transperitoneal ◽  
Post Operative Complications

ObjectiveLymphadenectomy is an integral part of surgical staging and treatment for patients with gynecologic malignancies. Since its introduction, laparoscopic lymphadenectomy has proved feasible, safe, and oncologically adequate compared with open surgery while morbidity is lower and hospital stay considerably shorter. The aim of this study was to examine if surgical outcomes may be improved after the initial learning curve is complete.MethodsAn analysis of 2535 laparoscopic pelvic and/or para-aortic lymphadenectomies was performed between July 1994 and March 2018 by one team of gynecologic oncology surgeons but with the consistent supervision of a consultant surgeon. Data were collected prospectively evaluating operative time, intra-operative and post-operative complications, number of lymph nodes, and body mass index (BMI). Previously published data of 650 patients treated after introduction of the method (period 1, 1994–2003) were compared with the latter 524 patients (period 2, 2014–2018).ResultsThe median age of the 2535 patients was 43 years (IQR 34–57). The most common indication for pelvic and/or para-aortic lymphadenectomy was cervical cancer (n=1893). Operative time for para-aortic lymph node dissection was shorter in period 2 (68 vs 100 min, p<0.001). The number of harvested lymph nodes was increased for pelvic (19.2 (range 2–52) vs 21.9 (range 4–87)) and para-aortic lymphadenectomy (10.8 (range 1–52) vs 14.4 (range 4–64)), p<0.001. BMI did not have a significant influence on node count or operative time, with BMI ranging from 14.6 to 54.1 kg/m2. In contrast to period 1 (n=18, 2.9%), there were no intra-operative complications in period 2 (n=0, 0.0%, p<0.001) whereas post-operative complications were similar (n=35 (5.8%) in period 1; n=38 (7.6%) in period 2; p=0.32).ConclusionIn this large cohort of patients who underwent laparoscopic transperitoneal lymphadenectomy, lymph node count and peri-operative complications improved after the initial learning curve.

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 &lt; 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.

scholarly journals Short-term and long-term outcomes of robotic, laparoscopic and open radical gastrectomy in gastric cancer: A single-center retrospective study

2019 ◽  
Author(s):  
Weifan Zhang ◽  
Xinhui Zhao ◽  
Zhao Liu ◽  
Hui Dang ◽  
Lei Meng ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Learning Curve ◽  
Operation Time ◽  
Open Gastrectomy ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Estimated Blood Loss

Abstract Background: Few studies on the comparison among robotic, laparoscopic, and open gastrectomy had been reported in gastric cancer . The goal of this study was to evaluate the advantages of robotic-assisted gastrectomy (RAG) by comparing with laparoscopic-assisted gastrectomy(LAG) and open gastrectomy (OG). Methods: 147 gastric cancer patients who underwent gastrectomy were enrolled and retrospectively analyzed between January 2017 and July 2019. Short-term outcomes such as operation time, intraoperative estimated blood loss(EBL),number of retrieved lymph nodes, postoperative recovery, learning curve, and long-term outcome such as overall survival(OS) was compared among RAG, LAG and OG groups. Results: RAG group included 47 patients, 44 in the LAG, and 61 in the OG. Basic information such as gender, age, BMI, ASA degree were similar among three groups, and there were no statistically significances in pathological TNM staging, tumor resection extent, resection margin, methods of reconstruction( P ＞0.05). The cumulative sum(CUSUM) method showed that learning curve of RAG reached stability after 17 cases . For short-term outcomes, the RAG group had the shortest EBL( P =0.033), the shortest time to first flatus( P ＜0.001), shortest time to first intake liquid diet ( P =0.004),shortest postoperative hospital stay ( P =0.023)and the largest number of retrieved lymph nodes( P =0.044),the longest operation time( P ＜0.001), the most expensive treatment cost( P ＜0.001),however, there were no significant differences in postoperative drainage, postoperative white blood cell(WBC)count and early complications among three group( P ＞0.05). In addition to long-term outcome, similar OS was observed in three groups. Conclusion: Compared with LAG and OG, RAG has certain advantages in short-term outcomes and is a safe and reliable surgical method. But still need further prospective, multi-center research to confirm this.

scholarly journals Short-term Outcomes After Robot-Assisted vs Open Pancreaticoduodenectomy After the Learning Curve

JAMA Surgery ◽  
2020 ◽  
Vol 155 (5) ◽  
pp. 389 ◽  
Author(s):  
Yusheng Shi ◽  
Jiabin Jin ◽  
Weihua Qiu ◽  
Yuanchi Weng ◽  
Jian Wang ◽  
...  
Keyword(s):  
Learning Curve ◽  
Robot Assisted ◽  
Short Term ◽  
Open Pancreaticoduodenectomy

scholarly journals Robot-assisted Nipple-sparing Mastectomy with Immediate Breast Reconstruction: An Initial Experience

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Hyung Seok Park ◽  
Jeea Lee ◽  
Dong Won Lee ◽  
Seung Yong Song ◽  
Dae Hyun Lew ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Learning Curve ◽  
Operation Time ◽  
Immediate Breast Reconstruction ◽  
Robot Assisted ◽  
Open Conversion ◽  
Areolar Complex ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Abstract Seeking smaller and indistinct incisions, physicians have attempted endoscopic breast surgery in breast cancer patients. Unfortunately, there are some limitations in the range of movement and visualization of the operation field. Potentially addressing these limitations, we investigated the outcomes of gas and gasless robot-assisted nipple-sparing mastectomy (RANSM) with immediate breast reconstruction (IBR). Ten patients underwent 12 RANSM with IBR between November 2016 and April 2018. Patients with tumors measuring >5 cm in diameter, tumor invasion of the skin or nipple-areolar complex, proven metastatic lymph nodes, or planned radiotherapy were excluded. Age, breast weight, diagnosis, tumor size, hormone receptor status, and operation time were retrospectively collected. Postoperative outcomes including postoperative complications and final margin status of resected were analyzed. The median total operation time and console time were 351 min (267–480 min) and 51 min (18–143 min), respectively. The learning curve presented as a cumulative sum graph showed that the console time decreased and then stabilized at the eighth case. There was no open conversion or major postoperative complication. One patient had self-resolved partial nipple ischemia, and two patients experienced partial skin ischemia. We deemed that RANSM with IBR is safe and feasible for early breast cancer, benign disease of the breast, and BRCA 1/2 mutation carriers. RANSM is an advanced surgical method with a short learning curve.

scholarly journals LEARNING CURVE OF ROBOT-ASSISTED MYOMECTOMY

2019 ◽  
Vol 6 (4) ◽  
pp. 221-224
Author(s):  
A. G Tyan ◽  
Ekaterina V. Slukhanchuk
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Retrospective Analysis ◽  
Average Duration ◽  
Reproductive Age ◽  
Robot Assisted ◽  
Extensive Experience ◽  
Intracorporeal Suturing ◽  
Surgical Interventions ◽  
The City

Introduction. Robot-assisted myomectomy is the most modern types of surgical interventions for uterine myoma in patients of reproductive age. It benefit in simplicity of intracorporeal suturing and lack of laparoscopic myomectomy limitations. Of great scientific interest is the speed of mastering the method. We studied the learning curve of a robot-assisted myomectomy based on our own experience. Material and methods. A retrospective analysis of the results of 45 robot-assisted operations for uterine myomas from August 2016 to June 2017 was performed at the City Clinical Hospital named after S.I. Spasokukotskiy. All operations were performed by a single surgeon with extensive experience in laparoscopic surgery. The surgeon had no experience of robotic operations. Results. According to a retrospective analysis, there was stromg correlation between the acquired experience of robotic surgery and such indicators as the average duration of the operation, the time of thermal ischemia and the volume of blood loss. Conclusion. The learning curve of a robot-assisted myomectomy for an experienced laparoscopic surgeon improves to 15 operations. This experience is enough to perform operations with a minimum duration, volume of blood loss and complications.

scholarly journals Learning Curve and Clinical Outcomes of Performing Surgery with the InterTan Intramedullary Nail in Treating Femoral Intertrochanteric Fractures

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
A-Bing Li ◽  
Wei-Jiang Zhang ◽  
Ji-Qi Wang ◽  
You-Ming Zhao ◽  
Wei-Jun Guo
Keyword(s):  
Learning Curve ◽  
Intramedullary Nail ◽  
Operative Time ◽  
Weight Bearing ◽  
Operation Time ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Partial Weight Bearing ◽  
Negative Exponential ◽  
Partial Weight

Purpose. The purpose of this study is to evaluate the learning curve of performing surgery with the InterTan intramedullary nail in treating femoral intertrochanteric fractures, to provide valuable information and experience for surgeons who decide to learn a new procedure. Methods. We retrospectively analyzed data from 53 patients who underwent surgery using an InterTan intramedullary nail at our hospital between July 2012 and September 2015. The negative exponential curve-fit regression analysis was used to evaluate the learning curve. According to 90% learning milestone, patients were divided into two group, and the outcomes were compared. Results. The mean operative time was 69.28 (95% CI 64.57 to 74.00) minutes; with the accumulation of surgical experience, the operation time was gradually decreased. 90% of the potential improvement was expected after 18 cases. In terms of operative time, intraoperative blood loss, hospital stay, and Harris hip score significant differences were found between two groups (p=0.009, p=0.000, p=0.030, and p=0.002, resp.). Partial weight bearing time, fracture union time, tip apex distance, and the number of blood transfusions and complications were similar between two groups (p>0.5). Conclusion. This study demonstrated that the learning curve of performing surgery with the InterTan intramedullary nail is acceptable and 90% of the expert’s proficiency level is achieved at around 18 cases.

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