Learning curve of patient specific templates for TKA. Assessment with a navigation system and the CUSUM test.

Computational fluid dynamics (CFD) simulations were performed for unsteady periodic breathing conditions, using large-scale models of the human lung airway. The computational domain included fully coupled representations of the orotracheal region and large conducting zone up to generation four (G4) obtained from patient-specific CT data, and the small conducting zone (to G16) obtained from a stochastically generated airway tree with statistically realistic geometrical characteristics. A reduced-order geometry was used, in which several airway branches in each generation were truncated, and only select flow paths were retained to G16. The inlet and outlet flow boundaries corresponded to the oronasal opening (superior), the inlet/outlet planes in terminal bronchioles (distal), and the unresolved airway boundaries arising from the truncation procedure (intermediate). The cyclic flow was specified according to the predicted ventilation patterns for a healthy adult male at three different activity levels, supplied by the whole-body modeling software HumMod. The CFD simulations were performed using Ansys FLUENT. The mass flow distribution at the distal boundaries was prescribed using a previously documented methodology, in which the percentage of the total flow for each boundary was first determined from a steady-state simulation with an applied flow rate equal to the average during the inhalation phase of the breathing cycle. The distal pressure boundary conditions for the steady-state simulation were set using a stochastic coupling procedure to ensure physiologically realistic flow conditions. The results show that: 1) physiologically realistic flow is obtained in the model, in terms of cyclic mass conservation and approximately uniform pressure distribution in the distal airways; 2) the predicted alveolar pressure is in good agreement with previously documented values; and 3) the use of reduced-order geometry modeling allows accurate and efficient simulation of large-scale breathing lung flow, provided care is taken to use a physiologically realistic geometry and to properly address the unsteady boundary conditions.

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Learning curve for robot-assisted Ivor Lewis esophagectomy

Diseases of the Esophagus ◽

10.1093/dote/doab026 ◽

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.

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TCT-737 MONITORING THE LEARNING CURVE AND QUALITY OF CARE IN TAVI PROCEDURES BY CUSUM ANALYSIS

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2013.08.1489 ◽

2013 ◽

Vol 62 (18) ◽

pp. B224-B225 ◽

Cited By ~ 1

Author(s):

Alfredo Giuseppe Cerillo ◽

Michele Murzi ◽

Massimiliano Mariani ◽

Federica Marchi ◽

Stefano Maffei ◽

...

Keyword(s):

Quality Of Care ◽

Learning Curve ◽

Cusum Analysis

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An internet-connected, patient-specific, deformable brain atlas integrated into a surgical navigation system

Journal of Digital Imaging ◽

10.1007/bf03168712 ◽

1997 ◽

Vol 10 (S1) ◽

pp. 231-237 ◽

Cited By ~ 3

Author(s):

Armond L. Levy ◽

Timothy J. Schaewe ◽

Michael I. Miller ◽

Kurt R. Smith ◽

Abed M. Hammoud ◽

...

Keyword(s):

Navigation System ◽

Surgical Navigation ◽

Brain Atlas ◽

Patient Specific ◽

Surgical Navigation System

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Patient-specific high-tibial osteotomy’s ‘cutting-guides’ decrease operating time and the number of fluoroscopic images taken after a Brief Learning Curve

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-019-05637-6 ◽

2019 ◽

Vol 28 (9) ◽

pp. 2854-2862 ◽

Cited By ~ 10

Author(s):

Christophe Jacquet ◽

Akash Sharma ◽

Maxime Fabre ◽

Matthieu Ehlinger ◽

Jean-Noël Argenson ◽

...

Keyword(s):

Learning Curve ◽

Operating Time ◽

Patient Specific ◽

Cutting Guides

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Incorporating New Technology Into a Surgical Technique: The Learning Curve of a Single Surgeon's Stereo-Electroencephalography Experience

Neurosurgery ◽

10.1093/neuros/nyz498 ◽

2019 ◽

Vol 86 (3) ◽

pp. E281-E289 ◽

Cited By ~ 1

Author(s):

Robert A McGovern ◽

Robert S Butler ◽

James Bena ◽

Jorge Gonzalez-Martinez

Keyword(s):

Surgical Technique ◽

Learning Curve ◽

Clinical Experience ◽

Imaging Modality ◽

Imaging Techniques ◽

New Technology ◽

Surgical Techniques ◽

Vascular Imaging ◽

New Paradigm ◽

Cusum Analysis

Abstract BACKGROUND Technological improvements frequently outpace the publication of randomized, controlled trials in surgical patients. This makes the application of new surgical techniques difficult as surgeons solely use clinical experience to guide changes in their practice. OBJECTIVE To quantitatively examine the learning curve of incorporating new technology into a surgical technique and discuss the clinical significance of incorporating this new technology into daily practice. To identify areas of improvement for operative efficiency and safety. METHODS A retrospective observational study examining quantitative measures of operative efficiency and safety from 2009 to 2017 in 454 consecutive patients undergoing stereo-electroencephalography depth electrode implantations. RESULTS The transition to a new robotic technique significantly improved operative times (196 min [95% CI 173-219] vs 115 min [95% CI 111-118], P < .0001). Cumulative sum (CUSUM) analysis demonstrated that mastery of the robotic technique took much longer than the frame-based technique (operative time peak at case 75 vs case 25, plateau of 150 vs 10 cases). Although hemorrhage rates using different vascular imaging techniques did not appear to differ using traditional statistical analysis (magnetic resonance imaging, MRI 22.3%, computed tomography angiography, CTA 17.9%, angiogram 18.1%, likelihood ratio χ2 = 4.84, P = .30), CUSUM analysis suggested MRI as the vascular imaging modality leading to higher hemorrhage and symptomatic hemorrhage rates at our center. CONCLUSION This experience demonstrates an improvement in operative efficiency through a series of changes made using clinical experience and intuition while transitioning to a completely new paradigm. CUSUM analysis identified potential areas for improvement in both operative efficiency and safety if used in a prospective manner.

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Accuracy of cup orientation and learning curve of the accelerometer-based portable navigation system for total hip arthroplasty in the supine position

Journal of Orthopaedic Surgery ◽

10.1177/2309499019848871 ◽

2019 ◽

Vol 27 (2) ◽

pp. 230949901984887 ◽

Cited By ~ 4

Author(s):

Tomoyuki Kamenaga ◽

Shinya Hayashi ◽

Shingo Hashimoto ◽

Tomoyuki Matsumoto ◽

Koji Takayama ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Learning Curve ◽

Hip Arthroplasty ◽

Supine Position ◽

Navigation System ◽

Total Hip ◽

Portable Navigation

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Single-Incision Laparoscopic Cholecystectomy: A Combined Analysis of Resident and Attending Learning Curves at a Single Institution

The American Surgeon ◽

10.1177/000313481207800148 ◽

2012 ◽

Vol 78 (1) ◽

pp. 119-124

Author(s):

Mark Joseph ◽

Michael Phillips ◽

Christopher C. Rupp

Keyword(s):

Laparoscopic Cholecystectomy ◽

Learning Curve ◽

Single Incision ◽

Learning Curves ◽

Patient Specific ◽

Short Learning Curve ◽

Significant Difference ◽

Surgeon Experience ◽

Standard Laparoscopic Cholecystectomy ◽

Single Incision Laparoscopic Cholecystectomy

Single-incision laparoscopic cholecystectomy (SILC) is a recent technical modification on standard laparoscopic cholecystectomy that has been shown to be safe and feasible. Recent studies suggest that experienced laparoscopic surgeons have a short learning curve to become proficient in SILC. However, little is known about the interaction of the learning curves of residents and attending surgeons at academic programs. We prospectively evaluated various metrics of both attending and resident surgeons as they progressed in their experience with SILC. Patients were placed into cohorts of 25 based on teaching surgeon experience. Data recorded included patient-specific and operative variables along with complications, conversion to standard laparoscopic cholecystectomy, and outcomes. One hundred one patients underwent SILC. Twelve per cent of patients required conversion to standard laparoscopic cholecystectomy. No significant difference was found in operative times compared within the experience-based cohorts ( P = 0.21). A reduction in operative time was shown in residents who were proficient in standard laparoscopic cholecystectomy (SLC) along their learning curve. Operative times remained the same for the teaching surgeon regardless of experience of resident surgeon. SILC has a short learning curve for resident surgeons who are proficient in standard laparoscopic surgery. SILC can be effectively taught with few complications and outcomes similar to SLC with preservation of operative efficiency and safety. Further studies are warranted, however, at a national/international level to define the place and use for SILC as well as the incorporation of single-incision techniques into resident curriculum.

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