Operative results and learning curve: microscope-assisted tubular microsurgery for 1- and 2-level discectomies and laminectomies

Object The authors present their clinical results and the learning curve associated with the use of tubular retractors for 1- and 2-level lumbar microscope-assisted discectomies and laminectomies. Methods The study involves a retrospective and prospective analysis of 230 patients who underwent noninstrumented minimally invasive procedures for degenerative lumbar spinal disease between 2004 and 2007. Data on patient demographic characteristics and operative results, including length of stay, blood loss, operative times, and surgical complications were collected. Clinical outcomes were assessed based on pre- and postoperative Visual Analog Scale scores, Oswestry Disability Index values, and the Macnab outcome scale scores. Results The results showed characteristic differences in blood loss and operating times between 1- and 2-level procedures and between discectomies and laminectomies. A significant learning curve was seen by a decrease in operating time for 1- level discectomies and 2-level laminectomies. Major complications were not observed. Conclusions The use of tubular retractors for microsurgical decompression of degenerative spinal disease is a safe and effective treatment modality. As with other techniques, minimally invasive procedures are associated with a significant learning curve. As surgeons become more comfortable with the procedure, its applications can be expanded to include, for example, spinal instrumentation and deformity correction.

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Short-term Results of Microendoscopic Muscle-preserving Interlaminar Decompression versus Spinal Process Splitting Laminectomy

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0037-1608871 ◽

2018 ◽

Vol 79 (06) ◽

pp. 511-517 ◽

Cited By ~ 1

Author(s):

Mitsunori Yoshimoto ◽

Noriyuki Iesato ◽

Yoshinori Terashima ◽

Tsuneo Takebayashi ◽

Toshihiko Yamashita ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Clinical Results ◽

Minimally Invasive Procedures ◽

Invasive Procedures ◽

Patient Satisfaction Score ◽

Spinal Process ◽

Significant Difference ◽

Patient Reported ◽

Time Required

Study Design A retrospective comparative study. Objective To compare retrospectively the clinical results and surgical invasiveness of two different types of minimally invasive surgery for lumbar spinal canal stenosis: microendoscopic muscle-preserving interlaminar decompression (ME-MILD) and spinal process splitting laminectomy (SPSL). Summary of Background Data ME-MILD and SPSL are minimally invasive procedures. However, the two procedures have not been compared in the literature. Materials and Methods We retrospectively enrolled patients who underwent ME-MILD or SPSL from 2011 to 2015. The surgical invasiveness of each technique was determined by evaluating the time required for the surgical procedure, amount of blood loss, serum creatine kinase (CK) levels on postoperative day (POD) 1, C-reactive protein (CRP) levels on POD 3 and 7, and the hospitalization. The clinical results were evaluated using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire score, the Short Form (36) Health Survey patient-reported outcome score, the visual analog scale for pain, a patient satisfaction score, and the incidence of surgical complications. Results A total of 97 patients were evaluated: 58 patients underwent ME-MILD, and 39 patients underwent SPSL. No significant differences were observed in the clinical results between the two groups. Regarding surgical invasiveness, no significant difference was found in the amount of blood loss, levels of CK, hospitalization, or time required for the procedure. However, CRP levels were significantly lower in the ME-MILD group. Conclusions ME-MILD and SPSL are both minimally invasive procedures. In a comparison of these two procedures, CRP was significantly lower in the ME-MILD group.

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Pediatric Robotic-Assisted Laparoscopy: A Description of the Principle Procedures

The Scientific World JOURNAL ◽

10.1100/tsw.2006.399 ◽

2006 ◽

Vol 6 ◽

pp. 2581-2588 ◽

Cited By ~ 19

Author(s):

Carlo Passerotti ◽

Craig A. Peters

Keyword(s):

Laparoscopic Surgery ◽

Minimally Invasive ◽

Learning Curve ◽

Robotic Assistance ◽

Minimally Invasive Procedures ◽

Invasive Procedures ◽

Robotic Assisted ◽

Conventional Laparoscopic ◽

Robotic Devices ◽

Robotic Assisted Laparoscopy

The advent of clinically useful robotic devices to facilitate reconstructive laparoscopic surgery in pediatric urology opens new doors to minimally invasive procedures. Previously limited by the challenge of delicate suturing and reconstruction using conventional laparoscopic instruments, robotic assistance offers a more rapid climb up the learning curve. Initial procedures that have been safely and efficaciously performed with robotic assistance include nephrectomy, partial nephrectomy, pyeloplasty, and antireflux surgeries. These techniques and their outcomes will be reviewed, as well as some of the challenges still posed by this methodology.

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P99 A STRUCTURED TRAINING PATHWAY TO IMPLEMENT ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): LEARNING CURVE RESULTS FROM A HIGH VOLUME CENTER

Diseases of the Esophagus ◽

10.1093/dote/doz092.99 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Kingma BF ◽

Hadzijusufovic E ◽

van der Sluis PC ◽

Lang H ◽

Ruurda JP ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Learning Curve ◽

Minimally Invasive Esophagectomy ◽

Operating Time ◽

Learning Curves ◽

Perioperative Outcomes ◽

Intraoperative Blood Loss ◽

Robot Assisted ◽

Invasive Esophagectomy

Abstract Aim The aim of this study was to describe the results of a structured training pathway that was developed to implement robot-assisted minimally invasive esophagectomy (RAMIE) in new centers. Background & Methods To safely and effectively implement RAMIE in new centers, the learning process needs to be optimized. In this context, a structured training pathway was created (Table 1). The results of this training pathway were investigated by evaluating consecutive patients who underwent RAMIE by a single surgeon who followed the structured training pathway. These patients were included from the trainee center’s prospective database. Cumulative sum (CUSUM) learning curves were plotted for thoracic operating time and intraoperative blood loss. Perioperative outcomes were compared between patients who underwent surgery before and after a learning curve plateau occurred. Results Between 2017-2018, the trainee team adhered to the structured training pathway and a total of 70 patients were included. The learning curves showed plateaus after 22 cases. In cases 23-70, the operating time was shorter for both the thoracic phase (median 215 vs. 249 minutes, P=0.001) and overall procedure (median 394 vs. 440 minutes, P=0.005), intraoperative blood loss was less (median 210 vs. 400 milliliters, P=0.029), and lymph node yield was higher (median 32 vs. 23 nodes, P=0.001) when compared to the first 22 cases. No significant differences were found for conversion rates, postoperative complications, length of hospital stay, radicality, or mortality. Conclusions The structured RAMIE training pathway results in a short learning curve and is an effective way to introduce RAMIE without compromising the oncological outcomes and complication rates. The pathway is therefore advised to surgeons who are willing to adopt this technique.

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