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Anaplioti E, Gkeka K, Katsakiori P, Peteinaris A, Tatanis V, Faitatziadis S, Pagonis K, Natsos A, Obaidat M, Vagionis A, Spinos T, Tsaturyan A, Vrettos T, Liatsikos E, Kallidonis P. How long do we need to reach sufficient expertise with the avatera® robotic system? Int Urol Nephrol 2024; 56:1577-1583. [PMID: 38175386 DOI: 10.1007/s11255-023-03914-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE To investigate the learning curve in four basic surgical skills in laparoscopic and robotic surgeries, and evaluate the approximate time needed to reach sufficient expertise in performing these tasks with the avatera® system. METHODS Twenty urology residents with no previous experience in dry-lab and robotic surgery were asked to complete four basic laparoscopic tasks (peg transfer, circle cutting, needle guidance, and suturing) laparoscopically and robotically. All participants were asked to complete the tasks first after watching the Uroweb educational material and, second, after undertaking a 2-hour training in robotic and laparoscopic dry-lab. Thereafter, all trainees continued to undertake 2-hour training programs until being able to complete the tasks with the avatera® robot at the desired time. Paired t test and one-way ANOVA test were used to analyze time differences between the groups. RESULTS Time needed to complete all tasks either robotically or laparoscopically was significantly less in the second compared to the first attempt for all Groups in each Task. In the robotic dry-lab, time needed to complete the tasks was significantly less than in the laparoscopic dry-lab. A significant effect of previous laparoscopic experience of the participants on the training time needed to achieve most of the goal times was detected. CONCLUSION The results of the study highlight the role of previous laparoscopic experience in the training time needed to achieve the performance time goals and demonstrate that the learning curve of basic surgical skills using the avatera® system is steeper than the laparoscopic one.
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Affiliation(s)
- Eirini Anaplioti
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Kristiana Gkeka
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Paraskevi Katsakiori
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Angelis Peteinaris
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Vasileios Tatanis
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Solon Faitatziadis
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Konstantinos Pagonis
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Anastasios Natsos
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Mohammed Obaidat
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Athanasios Vagionis
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Theodoros Spinos
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Arman Tsaturyan
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
- Department of Urology, Erebouni Medical Center, Yerevan, Armenia
| | - Theofanis Vrettos
- Department of Anesthesiology, University Hospital of Rion, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece.
- Medical University of Vienna, Vienna, Austria.
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
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Zhang X, Yu J, Zhu J, Wei H, Meng N, Hu M, Tang J. A meta-analysis of unilateral axillary approach for robotic surgery compared with open surgery for differentiated thyroid carcinoma. PLoS One 2024; 19:e0298153. [PMID: 38603661 PMCID: PMC11008900 DOI: 10.1371/journal.pone.0298153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/19/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE The Da Vinci Robot is the most advanced micro-control system in endoscopic surgical instruments and has gained a lot of valuable experience today. However, the technical feasibility and oncological safety of the robot over open surgery are still uncertain. This work is to systematically evaluate the efficacy of the unilateral axillary approach for robotic surgery compared to open surgery for differentiated thyroid carcinoma. METHODS PubMed, Embase, Cochrane Library, and Web of Science databases were utilized to search for relevant literatures of robotic thyroid surgery using unilateral axillary approach compared to open thyroid surgery, and a meta-analysis was performed using RevMan software version 5.3. Statistical analysis was performed through Mantle-Haenszel and inverse variance methods. RESULTS Twelve studies with a total of 2660 patients were included in the meta-analysis. The results showed that compared with the open group, the robotic group had a longer total thyroidectomy time, shorter hospital stay, less intraoperative bleeding, more postoperative drainage, fewer retrieved central lymph nodes, and higher cosmetic satisfaction (all P < 0.05). In contrast, temporary and permanent laryngeal recurrent nerve injury, temporary and permanent hypoparathyroidism or hypocalcemia, brachial plexus nerve injury, number of retrieved central lymph nodes, number of retrieved lymph nodes in the lateral cervical region, number of lymph node metastases in the lateral cervical region, hematoma, seroma, lymphatic leak, stimulated thyroglobulin (sTg) and unstimulated thyroglobulin (uTg), and the number and recurrence rate of patients with sTg <1ng/ml were not statistically different between the two groups (P > 0.05). CONCLUSIONS The unilateral axillary approach for robotic thyroid surgery may achieve outcomes similar to those of open surgery. Further validation is required in a prospective randomized controlled trial.
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Affiliation(s)
- Xinjun Zhang
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Junkang Yu
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Jinhui Zhu
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Haibo Wei
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Ning Meng
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Mingrong Hu
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Jingjie Tang
- Institute of Bioengineering and Medical Engineering, Guangdong Academy of Sciences, Guangzhou, Guangdong Province, China
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Xu P, Fang Q, Mai J, Zhao Z, Cao F, Wu D, Liu X. Gasless robot-assisted transaxillary hemithyroidectomy (RATH): learning curve and complications. BMC Surg 2024; 24:78. [PMID: 38431572 PMCID: PMC10909294 DOI: 10.1186/s12893-024-02366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE Gasless robot-assisted transaxillary hemithyroidectomy (RATH) is regarded as an alternative surgical option for thyroid operations. However, the associated steep learning curve is a clinical concern. This study evaluated the learning curve of RATH for surgeons without experience of endoscopic surgery and the early surgical outcomes of RATH. METHODS We conducted a retrospective study of patients who underwent gasless RATH and conventional hemithyroidectomy (CH) at Sun Yat-sen University Cancer Center, Guangzhou, China, from June 2021 to August 2022. The learning curve and early surgical outcomes of gasless RATH were evaluated. And the early surgical outcomes of gasless RATH were compared to CH. RESULTS In total, 105 patients who underwent gasless RATH and 104 patients who underwent CH were matched and assessed. The cumulative sum techniques (CUSUM) analysis showed that the peak point of gasless RATH operative time occurred at the 31st case. No clear single peak was identified in the CUSUM plot for drainage amount and blood loss. No significant difference in perioperative complications was observed between these two groups. Moreover, the number of postoperative patients who got sense of thyroid area traction were fewer in the gasless RATH group (n = 11, 10.5%) than in the CH group (n = 32, 30.8%). CONCLUSION Gasless RATH can be considered as an alternative approach to the conventional open procedure, as it is an easy remote access technique, with shorter learning curves and certain advantage such as less sense of thyroid area traction.
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Affiliation(s)
- Pengfei Xu
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China
| | - Qi Fang
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China
| | - Junhao Mai
- Department of Breast and Thyroid Surgery, Guangzhou Panyu Central Hospital, 8 Fuyu East Road, Guangzhou, Guangdong, 511400, P.R. China
| | - Zheng Zhao
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China
| | - Fei Cao
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China
| | - Di Wu
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China.
| | - Xuekui Liu
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China.
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Leijte E, De Blaauw I, Rosman C, Botden SMBI. Transferability of the robot assisted and laparoscopic suturing learning curves. J Robot Surg 2024; 18:56. [PMID: 38280121 PMCID: PMC10821960 DOI: 10.1007/s11701-023-01753-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/11/2023] [Indexed: 01/29/2024]
Abstract
Robot assisted surgery (RAS) is increasingly used, and besides conventional minimally invasive surgery (cMIS) surgeons are challenged to learn an increased array of skills. This study aimed to assess the influence of both learning curves on each other. A prospective randomized crossover study was performed. Participants without cMIS or RAS experience (Groups 1 and 2), and cMIS experienced, (Group 3) were recruited. Three suturing tasks (intracorporal suturing, tilted plane and anastomosis needle transfer) were performed on the EoSim cMIS simulator or RobotiX RAS simulator up to twenty repetitions. Subsequently, Groups 1 and 2 performed the tasks on the other modality. Outcomes were simulator parameters, validated composite and pass/fail scores. In total forty-three participants were recruited. Overall RAS suturing was better in Group 1 (cMIS followed by RAS tasks) and 3 (RAS tasks) versus Group 2 (RAS followed by cMIS tasks) for time (163 s and 157 s versus 193 s p = 0.004, p = 0.001) and composite scores (92/100 and 91/100 versus 89/100 p = 0.008, p = 0.020). The cMIS suturing was better for Group 2 versus 1 (time 287 s versus 349 s p = 0.005, composite score 96/100 versus 94/100 p = 0.002). Significant differences from the RAS suturing pass/fail were reached earlier by Group 3, followed by Groups 1 and 2 (repetition six, nine and twelve). In cMIS suturing Group 2 reached significant differences from the pass/fail earlier than Group 1 (repetition four versus six). Transferability of skills was shown for cMIS and RAS, indicating that suturing experience on cMIS or RAS is beneficial in learning either approach.
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Affiliation(s)
- E Leijte
- Department of Surgery, Radboud University Medical Centre, Geert Grooteplein 10 Route 618, 6500HB, Nijmegen, The Netherlands.
- Department of Paediatric Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - I De Blaauw
- Department of Paediatric Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C Rosman
- Department of Surgery, Radboud University Medical Centre, Geert Grooteplein 10 Route 618, 6500HB, Nijmegen, The Netherlands
| | - S M B I Botden
- Department of Paediatric Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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Jureidini R, Namur GN, Ribeiro TC, Bacchella T, Stolzemburg L, Jukemura J, Ribeiro Junior U, Cecconello I. ROBOTIC ASSISTED VERSUS LAPAROSCOPIC DISTAL PANCREATECTOMY: A RETROSPECTIVE STUDY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1783. [PMID: 38088728 PMCID: PMC10712921 DOI: 10.1590/0102-672020230065e1783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/22/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Minimally invasive distal pancreatectomy (MIDP) is associated with less blood loss and faster functional recovery. However, the benefits of robotic assisted distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) are unknown. AIMS To compare RDP versus LDP for surgical treatment of benign lesions, pre-malignant and borderline malignant pancreatic neoplasias. METHODS This is a retrospective study comparing LDP with RDP. Main outcomes were overall morbidity and overall costs. Secondary outcomes were pancreatic fistula (PF), infectious complications, readmission, operative time (OT) and length of hospital stay (LOS). RESULTS Thirty patients submitted to LDP and 29 submitted to RDP were included in the study. There was no difference regarding preoperative characteristics. There was no difference regarding overall complications (RDP - 72,4% versus LDP - 80%, p=0,49). Costs were superior for patients submitted to RDP (RDP=US$ 6,688 versus LDP=US$ 6,149, p=0,02), mostly due to higher costs of surgical materials (RDP=US$ 2,364 versus LDP=1,421, p=0,00005). Twenty-one patients submitted to RDP and 24 to LDP developed pancreatic fistula (PF), but only 4 RDP and 7 LDP experienced infectious complications associated with PF. OT (RDP=224 min. versus LDP=213 min., p=0.36) was similar, as well as conversion to open procedure (1 RDP and 2 LDP). CONCLUSIONS The postoperative morbidity of robotic distal pancreatectomy is comparable to laparoscopic distal pancreatectomy. However, the costs of robotic distal pancreatectomy are slightly higher.
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Affiliation(s)
- Ricardo Jureidini
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Guilherme Naccache Namur
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Thiago Costa Ribeiro
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Telesforo Bacchella
- Univesidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Lucas Stolzemburg
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
| | - José Jukemura
- Univesidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Ulysses Ribeiro Junior
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
- Univesidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Ivan Cecconello
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
- Univesidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
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Addison P, Bitner DP, Addy J, Dechario S, Husk G, Antonacci A, Talamini M, Giangola G, Filicori F. Does Surgeon Experience Correlate with Crowd-Sourced Skill Assessment in Robotic Bariatric Surgery? Am Surg 2023; 89:5253-5262. [PMID: 36454236 DOI: 10.1177/00031348221142586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND The Global Evaluative Assessment of Robotic Skills (GEARS) rubric provides a measure of skill in robotic surgery. We hypothesize surgery performed by more experienced operators will be associated with higher GEARS scores. METHOD Patients undergoing sleeve gastrectomy from 2016 to 2020 were analyzed. Three groups were defined by time in practice: less than 5, between 5 and 15, and more than 15 years. Continuous variables were compared with ANOVA and multivariable regression was performed. RESULTS Fourteen operators performing 154 cases were included. More experienced surgeons had higher GEARS scores and shorter operative times. On multivariable regression, operative time (P = 0.027), efficiency (P = .022), depth perception (P = 0.033), and bimanual dexterity (P = 0.047) were associated with experience. CONCLUSIONS In our video-based assessment (VBA) model, operative time and several GEARS subcomponent scores were associated with surgical experience. Further studies should determine the association between these metrics and surgical outcomes.
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Affiliation(s)
- Poppy Addison
- Intraoperative Performance Analytics Laboratory, Department of General Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Daniel P Bitner
- Intraoperative Performance Analytics Laboratory, Department of General Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Jermyn Addy
- Intraoperative Performance Analytics Laboratory, Department of General Surgery, Lenox Hill Hospital, New York, NY, USA
| | | | - Gregg Husk
- Intraoperative Performance Analytics Laboratory, Department of General Surgery, Lenox Hill Hospital, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Anthony Antonacci
- Intraoperative Performance Analytics Laboratory, Department of General Surgery, Lenox Hill Hospital, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Mark Talamini
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of General Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - Gary Giangola
- Intraoperative Performance Analytics Laboratory, Department of General Surgery, Lenox Hill Hospital, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Filippo Filicori
- Intraoperative Performance Analytics Laboratory, Department of General Surgery, Lenox Hill Hospital, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Teixeira A, Jawad M, Ghanem M, Sánchez A, Petrola C, Lind R. Analysis of the Impact of the Learning Curve on the Safety Outcome of the Totally Robotic-Assisted Biliopancreatic Diversion with Duodenal Switch: a Single-Institution Observational Study. Obes Surg 2023; 33:2742-2748. [PMID: 37440110 DOI: 10.1007/s11695-023-06719-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Totally robotic-assisted biliopancreatic diversion with duodenal switch (BPD/DS) learning curve has been described to be longer at approximately 50 cases, at which point operative time and complications rate decrease and tend to stabilize. This study aimed to form an analysis of the impact of the learning curve on the safety outcomes of the totally robotic-assisted BPD/DS. METHODS A retrospective review of patients who underwent primary totally robotic-assisted BPD/DS by one of our certified bariatric and metabolic surgeon member of our institution was performed. The patients were classified into two groups, the learning stage group (first 50 cases) and the mastery stage group. Differences in operative time in minutes and postoperative outcomes were analyzed. RESULTS Two hundred seventy-six patients were included. The operative time and the postoperative length of stay were significantly higher in the learning stage group (173.8 ± 35.8 min vs. 139.2 ± 30.2 min, p= 0.0001; 3.4 ± 1.4 days vs. 2.6 ± 0.9 days, p= 0.0002). The overall leakage rate was significantly higher in the learning stage group (8% vs. 0.4%, p= 0.0001). The global rate of complications for the learning stage group was 14%, and for the mastery stage group was 6.6% (p= 0.08). CONCLUSIONS After the first 50 cases, the operative time, the length of stay, and the overall rate of complications decreased, being especially significant the decrease in the duodeno-ileal anastomosis leakage rate after reaching the learning curve.
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Affiliation(s)
- Andre Teixeira
- Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, USA
| | - Muhammad Jawad
- Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, USA
| | - Muhammad Ghanem
- Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, USA
| | - Alexis Sánchez
- Corporate Director Robotic Surgery Program, Orlando Health, Orlando, USA
| | - Carlos Petrola
- Research Fellow, Robotic Surgery Program, Orlando Health, Orlando, USA.
- General and Digestive Surgery Department, Hospital Universitari Joan XXIII, Carrer Dr. Mallafre Guasch 4, ZIP: 43005, Tarragona, Spain.
| | - Romulo Lind
- Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, USA
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Hazen JK, Scott DJ, Holcomb CN. The effect of bedside assistant technical performance on outcomes in robotic surgery. J Robot Surg 2023; 17:711-718. [PMID: 36413256 DOI: 10.1007/s11701-022-01497-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
Technical performance in surgery has been associated with patient outcomes. Robotic surgery is unique in that both a console surgeon and bedside surgeon are required. A systematic review according to PRISMA guidelines identified all pertinent literature regarding skill level of the bedside assistant with regards to patient outcomes in robotic surgery. 10 studies met inclusion criteria. In all studies, the skill level of the assistant was based on experience, either by post-graduate year of the resident or number of cases previously performed by the assistant. Five studies reported significant, shorter operative times with increasing experience of the bedside assistant. No study reported a significant difference in postoperative outcomes. The existing literature fails to show improved patient outcomes with more experienced bedside assistants in robotic surgery. Metrics should be developed to measure actual technical performance of the bedside assistant rather than using arbitrary assessments of experience in future studies.
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Affiliation(s)
- James K Hazen
- Division of Bariatric and Foregut Surgery, Department of Surgery, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390-9158, USA
| | - Daniel J Scott
- Division of Bariatric and Foregut Surgery, Department of Surgery, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390-9158, USA
| | - Carla N Holcomb
- Division of Bariatric and Foregut Surgery, Department of Surgery, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390-9158, USA.
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Hardon SF, Willuth E, Rahimi AM, Lang F, Haney CM, Felinska EA, Kowalewski KF, Müller-Stich BP, van der Peet DL, Daams F, Nickel F, Horeman T. Crossover-effects in technical skills between laparoscopy and robot-assisted surgery. Surg Endosc 2023:10.1007/s00464-023-10045-6. [PMID: 37097456 PMCID: PMC10338573 DOI: 10.1007/s00464-023-10045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/25/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Robot-assisted surgery is often performed by experienced laparoscopic surgeons. However, this technique requires a different set of technical skills and surgeons are expected to alternate between these approaches. The aim of this study is to investigate the crossover effects when switching between laparoscopic and robot-assisted surgery. METHODS An international multicentre crossover study was conducted. Trainees with distinctly different levels of experience were divided into three groups (novice, intermediate, expert). Each trainee performed six trials of a standardized suturing task using a laparoscopic box trainer and six trials using the da Vinci surgical robot. Both systems were equipped with the ForceSense system, measuring five force-based parameters for objective assessment of tissue handling skills. Statistical comparison was done between the sixth and seventh trial to identify transition effects. Unexpected changes in parameter outcomes after the seventh trial were further investigated. RESULTS A total of 720 trials, performed by 60 participants, were analysed. The expert group increased their tissue handling forces with 46% (maximum impulse 11.5 N/s to 16.8 N/s, p = 0.05), when switching from robot-assisted surgery to laparoscopy. When switching from laparoscopy to robot-assisted surgery, intermediates and experts significantly decreased in motion efficiency (time (sec), resp. 68 vs. 100, p = 0.05, and 44 vs. 84, p = 0.05). Further investigation between the seventh and ninth trial showed that the intermediate group increased their force exertion with 78% (5.1 N vs. 9.1 N, p = 0.04), when switching to robot-assisted surgery. CONCLUSION The crossover effects in technical skills between laparoscopic and robot-assisted surgery are highly depended on the prior experience with laparoscopic surgery. Where experts can alternate between approaches without impairment of technical skills, novices and intermediates should be aware of decay in efficiency of movement and tissue handling skills that could impact patient safety. Therefore, additional simulation training is advised to prevent from undesired events.
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Affiliation(s)
- Sem F Hardon
- Department of Surgery, Amsterdam UMC - VU University Medical Center, ZH 7F 005 De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - E Willuth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - A Masie Rahimi
- Department of Surgery, Amsterdam UMC - VU University Medical Center, ZH 7F 005 De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Skills Centre for Health Sciences, Amsterdam, The Netherlands
| | - F Lang
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Caelan M Haney
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Eleni A Felinska
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Karl-Friedrich Kowalewski
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Donald L van der Peet
- Department of Surgery, Amsterdam UMC - VU University Medical Center, ZH 7F 005 De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC - VU University Medical Center, ZH 7F 005 De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Tim Horeman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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de Rezende BB, Assumpção LR, Haddad R, Terra RM, Marques RG. Characteristics of the learning curve in robotic thoracic surgery in an emerging country. J Robot Surg 2023:10.1007/s11701-023-01590-2. [PMID: 37083992 DOI: 10.1007/s11701-023-01590-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/26/2023] [Indexed: 04/22/2023]
Abstract
It is not established which factors impact the learning curve (LC) in robotic thoracic surgery (RTS), especially in emerging countries. The aim of this study is to analyze LC in RTS in Brazil and identify factors that can accelerate LC. We selected the first cases of two Brazilian surgeons who started their LC. We used CUSUM and the Lowess technique to measure LC for each surgeon and Poisson regression to assess factors associated with shorter console time (CT). 58 patients were operated by each surgeon and included in the analysis. Surgeries performed were different: Surgeon I (SI) performed 54 lobectomies (93.11%), whereas Surgeon II (SII) had a varied mix of cases. SI was proctored in his first 10 cases (17.24%), while SII in his first 41 cases (70.68%). The mean interval between surgeries was 8 days for SI and 16 days for SII. There were differences in the LC phases of the two surgeons, mainly regarding complications and conversions. There was shorter CT by 30% in the presence of a proctor, and by 20% with the Da Vinci Xi. Mix of cases did not seem to contribute to faster LC. Higher frequency between surgeries seems to be associated with a faster curve. Presence of proctor and use of bolder technologies reduced console time. We wonder if in phase 3 it is necessary to keep a proctor on complex cases to avoid serious complications. More studies are necessary to understand which factors impact the LC.
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Affiliation(s)
- Bruna Brandão de Rezende
- Universidade do Estado do Rio de Janeiro, Pós Graduação em Fisiopatologia e Ciências Cirúrgicas, Rio de Janeiro, RJ, Brazil.
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Lia Roque Assumpção
- Universidade do Estado do Rio de Janeiro, Pós Graduação em Fisiopatologia e Ciências Cirúrgicas, Rio de Janeiro, RJ, Brazil
| | - Rui Haddad
- Departamento de Cirurgia, Pontifícia Universidade Católica - PUC-RIO, Rio de Janeiro, RJ, Brazil
| | - Ricardo Mingarini Terra
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ruy Garcia Marques
- Universidade do Estado do Rio de Janeiro, Pós Graduação em Fisiopatologia e Ciências Cirúrgicas, Rio de Janeiro, RJ, Brazil
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11
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Mazzola M, Giani A, Veronesi V, Bernasconi DP, Benedetti A, Magistro C, Bertoglio CL, De Martini P, Ferrari G. Multidimensional evaluation of the learning curve for totally laparoscopic pancreaticoduodenectomy: a risk-adjusted cumulative summation analysis. HPB (Oxford) 2023; 25:507-517. [PMID: 36872109 DOI: 10.1016/j.hpb.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Laparoscopic pancreaticoduodenectomy (LPD) is a challenging procedure. We investigated the learning curve (LC) for LPD with a multidimensional analysis. METHODS Data of patients undergoing LPD between 2017 and 2021, operated by a single surgeon, were considered. A multidimensional assessment of the LC was performed through Cumulative Sum (CUSUM) and Risk-Adjusted (RA)-CUSUM analysis. RESULTS 113 patients were selected. Rates of conversion, overall postoperative complication, severe complication and mortality were 4%, 53%, 29% and 4%, respectively. RA-CUSUM analysis showed a LC with three phases: competency (procedures 1-51), proficiency (procedures 52-94), and mastery (after procedure 94). Operative time was lower in both phase two (588.17 vs 541.13 min, p = 0.001) and three (534.72 vs 541.13 min, p = 0.004) with respect to phase one. Severe complication rate was lower in mastery as compared to competency phase (42% vs 6%, p = 0.005). During mastery phase a greater number of lymph nodes was harvested in comparison to proficiency phase. CONCLUSIONS According to our LC analysis, 52 procedures were required to achieve technical competency in LPD. Mastery, which corresponded to a reduction in operative time and surgical failures, was acquired after 94 procedures.
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Affiliation(s)
- Michele Mazzola
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy.
| | - Alessandro Giani
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Valentina Veronesi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milan - Bicocca, Monza, Italy
| | - Davide P Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milan - Bicocca, Monza, Italy; ASST Grande Ospedale Metropolitano Niguarda, Department of Advanced Training Research and Development, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Antonio Benedetti
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Carmelo Magistro
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Camillo L Bertoglio
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Paolo De Martini
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Giovanni Ferrari
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
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12
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Burghgraef TA, Sikkenk DJ, Crolla RMPH, Fahim M, Melenhorst J, Moumni ME, Schelling GVD, Smits AB, Stassen LPS, Verheijen PM, Consten ECJ. Assessing the learning curve of robot-assisted total mesorectal excision: a multicenter study considering procedural safety, pathological safety, and efficiency. Int J Colorectal Dis 2023; 38:9. [PMID: 36630001 PMCID: PMC9834356 DOI: 10.1007/s00384-022-04303-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Evidence regarding the learning curve of robot-assisted total mesorectal excision is scarce and of low quality. Case-mix is mostly not taken into account, and learning curves are based on operative time, while preferably clinical outcomes and literature-based limits should be used. Therefore, this study aims to assess the learning curve of robot-assisted total mesorectal excision. METHODS A retrospective study was performed in four Dutch centers. The primary aim was to assess the safety of the individual and institutional learning curves using a RA-CUSUM analysis based on intraoperative complications, major postoperative complications, and compound pathological outcome (positive circumferential margin or incomplete TME specimen). The learning curve for efficiency was assessed using a LC-CUSUM analysis for operative time. Outcomes of patients before and after the learning curve were compared. RESULTS In this study, seven participating surgeons performed robot-assisted total mesorectal excisions in 531 patients. Learning curves for intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined literature-based limits. The LC-CUSUM for operative time showed lengths of the learning curve ranging from 12 to 35 cases. Intraoperative, postoperative, and pathological outcomes did not differ between patients operated during and after the learning curve. CONCLUSION The learning curve of robot-assisted total mesorectal excision based on intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined limits and is therefore suggested to be safe. Using operative time as a surrogate for efficiency, the learning curve is estimated to be between 12 and 35 procedures.
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Affiliation(s)
- T A Burghgraef
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
| | - D J Sikkenk
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - R M P H Crolla
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - M Fahim
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - J Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M El Moumni
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - A B Smits
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - L P S Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P M Verheijen
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - E C J Consten
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
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Gonçalves MR, Novo de Matos J, Oliveira A, Marinho R, Cadime I, Carlos Alves P, Morales-Conde S, Sousa MCB. Robotic4all project: Results of a hands-on robotic surgery training program. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2023. [DOI: 10.1016/j.lers.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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14
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Green CA, Lin JA, Huang E, O'Sullivan P, Higgins RM. Enhancing robotic efficiency through the eyes of robotic surgeons: sub-analysis of the expertise in perception during robotic surgery (ExPeRtS) study. Surg Endosc 2023; 37:571-579. [PMID: 35579701 DOI: 10.1007/s00464-022-09315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 04/27/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Robotic technology affords surgeons many novel and useful features, but two stereotypes continue to prevail: robotic surgery is expensive and inefficient. To identify educational opportunities and improve operative efficiency, we analyzed expert commentary on videos of robotic surgery. METHODS Expert robotic surgeons, identified through high case volumes and contributions to the surgical literature, reviewed eight anonymous video clips portraying key portions of two robotic general surgery procedures. While watching, surgeons commented on what they saw on the screen. All interactions with participants were in person, recorded, transcribed, and subsequently analyzed. Using content analysis, researchers double-coded each transcript applying a consensus developed codebook. RESULTS Seventeen surgeons participated. The average participant was male (82.4%), 47 (SD = 6.6) years old, had 13.2 (SD = 8.23) years of teaching experience, worked in urban academic hospitals (64.7%) and had performed 643 (SD = 467) robotic operations at the time of interviews. Emphasis on efficiency (or lack thereof) surfaced across three main themes: overall case progression, robotic capabilities, and instrumentation. Experts verbally rewarded purposeful and "ergonomically sound" movements while language reflecting impatience with repetitive and indecisive movements was attributed to presumed inexperience. Efficient robotic capabilities included enhanced visualization, additional robotic arms to improve exposure, and wristed instruments. Finally, experts discussed instrument selection with regards to energy modality, safety features, cost, and versatility. CONCLUSION This study highlights three areas for improved efficiency: case progression, robotic capabilities, and instrumentation. Development of education materials within these themes could help surgical educators overcome one of robotic technology's persistent challenges.
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Affiliation(s)
- Courtney A Green
- Division of Trauma, Department of Surgery, Critical Care and General Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Joseph A Lin
- Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143-0470, USA
| | - Emily Huang
- Department of Surgery, The Ohio State University Wexner Medical Center, Suite 670, 395 W. 12th Avenue, Columbus, OH, 43210-1267, USA
| | - Patricia O'Sullivan
- Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143-0470, USA.,Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, Room M994, San Francisco, CA, 94122, USA
| | - Rana M Higgins
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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15
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Pakkasjärvi N, Krishnan N, Ripatti L, Anand S. Learning Curves in Pediatric Robot-Assisted Pyeloplasty: A Systematic Review. J Clin Med 2022; 11:jcm11236935. [PMID: 36498510 PMCID: PMC9737296 DOI: 10.3390/jcm11236935] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Robot-assisted surgery demands a specific skillset of surgical knowledge, skills, and attitudes from the robotic surgeon to function as part of the robotic team and for maximal utility of the assistive surgical robot. Subsequently, the learning process of robot-assisted surgery entails new modes of learning. We sought to systematically summarize the published data on pediatric robot-assisted pyeloplasty (pRALP) to decipher the learning process by analyzing learning curves. Methods: This review followed the PRISMA guidelines. PubMed, EMBASE, Web of Science, and Scopus databases were systematically searched for ‘learning curve’ AND ‘pediatric pyeloplasty’. All studies presenting outcomes of learning curves (LC) in the context of pRALP in patients < 18 years of age were included. Studies comparing LC in pRALP versus open and/or laparoscopic pyeloplasty were also included; however, those solely focusing on LC in non-robotic approaches were excluded. The methodological quality was assessed using the Newcastle and Ottawa scale. Results: Competency was non-uniformly defined in all fifteen studies addressing learning curves in pRALP. pRALP was considered safe at all stages. Proficiency in pRALP was reached after 18 cases, while competency was estimated to demand 31 operated cases with operative duration as outcome variable. Conclusions: Pediatric RALP is safe during the learning process and ‘learning by doing’ improves efficiency. Competencies with broader implications than time must be defined for future studies.
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Affiliation(s)
- Niklas Pakkasjärvi
- Department of Pediatric Surgery, Turku University Hospital, 20521 Turku, Finland
| | - Nellai Krishnan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Liisi Ripatti
- Department of Pediatric Surgery, Turku University Hospital, 20521 Turku, Finland
| | - Sachit Anand
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
- Correspondence: ; Tel.: +91-9654215906
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16
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Burghgraef TA, Sikkenk DJ, Verheijen PM, Moumni ME, Hompes R, Consten ECJ. The learning curve of laparoscopic, robot-assisted and transanal total mesorectal excisions: a systematic review. Surg Endosc 2022; 36:6337-6360. [PMID: 35697853 PMCID: PMC9402498 DOI: 10.1007/s00464-022-09087-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The standard treatment of rectal carcinoma is surgical resection according to the total mesorectal excision principle, either by open, laparoscopic, robot-assisted or transanal technique. No clear consensus exists regarding the length of the learning curve for the minimal invasive techniques. This systematic review aims to provide an overview of the current literature regarding the learning curve of minimal invasive TME. METHODS A systematic literature search was performed. PubMed, Embase and Cochrane Library were searched for studies with the primary or secondary aim to assess the learning curve of either laparoscopic, robot-assisted or transanal TME for rectal cancer. The primary outcome was length of the learning curve per minimal invasive technique. Descriptive statistics were used to present results and the MINORS tool was used to assess risk of bias. RESULTS 45 studies, with 7562 patients, were included in this systematic review. Length of the learning curve based on intraoperative complications, postoperative complications, pathological outcomes, or a composite endpoint using a risk-adjusted CUSUM analysis was 50 procedures for the laparoscopic technique, 32-75 procedures for the robot-assisted technique and 36-54 procedures for the transanal technique. Due to the low quality of studies and a high level of heterogeneity a meta-analysis could not be performed. Heterogeneity was caused by patient-related factors, surgeon-related factors and differences in statistical methods. CONCLUSION Current high-quality literature regarding length of the learning curve of minimal invasive TME techniques is scarce. Available literature suggests equal lengths of the learning curves of laparoscopic, robot-assisted and transanal TME. Well-designed studies, using adequate statistical methods are required to properly assess the learning curve, while taking into account patient-related and surgeon-related factors.
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Affiliation(s)
- Thijs A Burghgraef
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands.
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | - Daan J Sikkenk
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
| | - Paul M Verheijen
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
| | - Mostafa El Moumni
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Roel Hompes
- Department of Surgery, University Medical Center Amsterdam, Location AMC, Amsterdam, the Netherlands
| | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
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17
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Merriman AL, Tarr ME, Kasten KR, Myers EM. A resident robotic curriculum utilizing self-selection and a web-based feedback tool. J Robot Surg 2022; 17:383-392. [PMID: 35696047 DOI: 10.1007/s11701-022-01428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
To describe an obstetrics and gynecology residency robotic curriculum, facilitated by a web-based feedback and case-tracking tool, allowing for self-selection into advanced training. Phase I (Basic) was required for all residents and included online training modules, online assessment, and robotic bedside assistant dry lab. Phase II (Advanced) was elective console training. Before live surgery, 10 simulation drills completed to proficiency were required. A web-based tool was used for surgical feedback and case-tracking. Online assessments, drill reports, objective GEARS assessments, subjective feedback, and case-logs were reviewed (7/2018-6/2019). A satisfaction survey was reviewed. Twenty four residents completed Phase I training and 10 completed Phase II. To reach simulation proficiency, residents spent a median of 4.1 h performing required simulation drills (median of 10 (3, 26) attempts per drill) before live surgery. 128 post-surgical feedback entries were completed after performance as bedside assistant (75%, n = 96) and console surgeon (5.5%, n = 7). The most common procedure was hysterectomy 111/193 (58%). Resident console surgeons performed portions of 32 cases with a mean console time of 34.6 ± 19.5 min. Mean GEARS score 20.6 ± 3.7 (n = 28). Mean non-technical feedback results: communication (4.2 ± 0.8, n = 61), workload management (3.9 ± 0.9, n = 54), team skills (4.3 ± 0.8, n = 60). Residents completing > 50% of case assessed as "apprentice" 38.5% or "competent" 23% (n = 13). After curriculum change, 100% of surveyed attendings considered residents prepared for live surgical training, vs 17% (n = 6) prior to curriculum change [survey response rate 27/44 (61%)]. Attendings and residents were satisfied with curriculum; 95% and recommended continued use 90% (n = 19).This two-phase robotic curriculum allows residents to self-select into advanced training, alleviating many challenges of graduated robotic training.
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Affiliation(s)
- Amanda L Merriman
- Division of Urogynecology and Pelvic Surgery, Department of Obstetrics and Gynecology, Atrium Health, Charlotte, NC, USA.
| | - Megan E Tarr
- Division of Urogynecology and Pelvic Surgery, Department of Obstetrics and Gynecology, Atrium Health, Charlotte, NC, USA
| | - Kevin R Kasten
- Division of Colorectal Surgery, Department of Surgery, Atrium Health, Charlotte, NC, USA
| | - Erinn M Myers
- Division of Urogynecology and Pelvic Surgery, Department of Obstetrics and Gynecology, Atrium Health, Charlotte, NC, USA
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18
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Shaw RD, Eid MA, Bleicher J, Broecker J, Caesar B, Chin R, Meyer C, Mitsakos A, Stolarksi AE, Theiss L, Smith BK, Ivatury SJ. Current Barriers in Robotic Surgery Training for General Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2022; 79:606-613. [PMID: 34844897 DOI: 10.1016/j.jsurg.2021.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/01/2021] [Accepted: 11/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess the current barriers in robotic surgery training for general surgery residents. DESIGN Multi-institutional web-based survey. SETTING 9 academic medical centers with a general surgery residency. PARTICIPANTS General surgery residents of at least PGY-3 training level. RESULTS 163 general surgery residents were contacted with 80 responses (49.1%). The most common responders were PGY-3s (38.8%) followed by PGY-5s (27.5%). The Northeast represented 42.5% of responses. Colorectal cases were the most common robotic case residents were involved in (51.3%). Residents' typical roles were assisting at the bedside (31.3%) and splitting time between assisting at the bedside and operating at the surgeon console (31.3%). 43% report to be either extremely or somewhat dissatisfied with their robotic surgery experience. 62.5% report they do not intend to integrate robotic surgery into their future practice. 93.8% of residents have a standardized robotic curriculum. 47.5% report using the simulator only during required didactic time with 52.5% having the robotic simulator conveniently located. The majority of residents report that the presence of dual consoles and first-assists in robotic cases enhance their robotic training (93% - 62%, respectively). 72.5% felt like they had more autonomy during laparoscopic cases and 96.8% of residents felt that an attendings' lack of experience impacted their time operating at the surgeon console. CONCLUSIONS General surgery residents report lack of effective OR teaching, real clinical experience, and simulated experience as main barriers in their robotic surgery training. Dual consoles and first-assistants are favorably looked upon. Lack of attending experience and comfort were universally negatively associated with resident participation. For residents interested in robotic surgery, advocating for more robust investment in dual consoles, first-assistants, and faculty development would likely improve their robotic surgery training experience. However, residency programs should consider whether robotic surgery should be a core competency of an already time restricted training paradigm.
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Affiliation(s)
- Robert D Shaw
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Mark A Eid
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; VA Outcomes Group, VA Quality Scholars Program; Geisel School of Medicine, Hanover, New Hampshire
| | - Josh Bleicher
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Justine Broecker
- Department of Surgery, Mayo-Clinic Florida, Jacksonville, Florida
| | - Ben Caesar
- Department of Surgery, Maine Medical Center, Portland, Maine
| | - Ryan Chin
- Department of Surgery, Montefiore Medical Center, New York, New York
| | - Courtney Meyer
- Department of Surgery, Emory University, Atlanta, Georgia
| | | | - Allan E Stolarksi
- Department of Surgery, Boston University | Boston Medical Center, Boston, Massachusetts
| | - Lauren Theiss
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Srinivas J Ivatury
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, Taxas
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19
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Cormi C, Parpex G, Julio C, Ecarnot F, Laplanche D, Vannieuwenhuyse G, Duclos A, Sanchez S. Understanding the surgeon's behaviour during robot-assisted surgery: protocol for the qualitative Behav'Robot study. BMJ Open 2022; 12:e056002. [PMID: 35393313 PMCID: PMC8991054 DOI: 10.1136/bmjopen-2021-056002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Robot-assisted surgery is spreading worldwide, accounting for more than 1.2 million procedures in 2019. Data are sparse in the literature regarding the surgeon's mechanisms that mediate risk-taking during a procedure, especially robot-assisted. This study aims to describe and understand the behaviour of the surgeons during robot-assisted surgery and the change in their behaviour with increasing experience in using the robot. METHODS AND ANALYSIS This is a qualitative study using semistructured interviews with surgeons who perform robot-assisted surgery. An interview guide comprising open questions will be used to ensure that the points to be discussed are systematically addressed during each interview (ie, (1) difference in behaviour and preparation of the surgeon between a standard procedure and a robot-assisted procedure; (2) the influence of proprioceptive modifications, gain in stability and cognitive biases, inherent in the use of a surgical robot and (3) the intrinsic effect of the learning curve on the behaviour of the surgeons. After transcription, interviews will be analysed with the help of NVivo software, using thematic analysis. ETHICS AND DISSEMINATION Since this project examines professional practices in the field of social and human sciences, ethics committee was not required in accordance with current French legislation (Decree no 2017-884, 9 May 2017). Consent from the surgeons is implied by the fact that the interviews are voluntary. Surgeons will nonetheless be informed that they are free to interrupt the interview at any time.Results will be presented in peer-reviewed national and international congresses and submitted to peer-reviewed journals for publication. The communication and publication of the results will be placed under the responsibility of the principal investigator and publications will be prepared in compliance with the ICMJE uniform requirements for manuscripts. TRIAL REGISTRATION NUMBER NCT04869995.
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Affiliation(s)
- Clément Cormi
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Troyes, France
- LIST3N/Tech-CICO, Université de Technologie de Troyes, Troyes, France
| | - Guillaume Parpex
- Department of Gynecology Obstetrics II and Reproductive Medicine, Hôpital Cochin, Paris, France
| | - Camille Julio
- Department of Digestive Surgery, Hôpital Saint-Louis, Paris, France
| | - Fiona Ecarnot
- EA3920, Burgundy Franche-Comté University, Besancon, France
| | - David Laplanche
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Troyes, France
| | - Geoffrey Vannieuwenhuyse
- Département de chirurgie gynécologique, mammaire et carcinologique, Centre Hospitalier de Troyes, Troyes, France
| | - Antoine Duclos
- Health Data Department, Hospices Civils de Lyon, Lyon, France
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphane Sanchez
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Troyes, France
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Müller PC, Kuemmerli C, Cizmic A, Sinz S, Probst P, de Santibanes M, Shrikhande SV, Tschuor C, Loos M, Mehrabi A, Z’graggen K, Müller-Stich BP, Hackert T, Büchler MW, Nickel F. Learning Curves in Open, Laparoscopic, and Robotic Pancreatic Surgery: A Systematic Review and Proposal of a Standardization. ANNALS OF SURGERY OPEN 2022; 3:e111. [PMID: 37600094 PMCID: PMC10431463 DOI: 10.1097/as9.0000000000000111] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 12/31/2022] Open
Abstract
Objective To depict and analyze learning curves for open, laparoscopic, and robotic pancreatoduodenectomy (PD) and distal pancreatectomy (DP). Background Formal training is recommended for safe introduction of pancreatic surgery but definitions of learning curves vary and have not been standardized. Methods A systematic search on PubMed, Web of Science, and CENTRAL databases identified studies on learning curves in pancreatic surgery. Primary outcome was the number needed to reach the learning curve as defined by the included studies. Secondary outcomes included endpoints defining learning curves, methods of analysis (statistical/arbitrary), and classification of learning phases. Results Out of 1115 articles, 66 studies with 14,206 patients were included. Thirty-five studies (53%) based the learning curve analysis on statistical calculations. Most often used parameters to define learning curves were operative time (n = 51), blood loss (n = 17), and complications (n = 10). The number of procedures to surpass a first phase of learning curve was 30 (20-50) for open PD, 39 (11-60) for laparoscopic PD, 25 (8-100) for robotic PD (P = 0.521), 16 (3-17) for laparoscopic DP, and 15 (5-37) for robotic DP (P = 0.914). In a three-phase model, intraoperative parameters improved earlier (first to second phase: operating time -15%, blood loss -29%) whereas postoperative parameters improved later (second to third phase: complications -46%, postoperative pancreatic fistula -48%). Studies with higher sample sizes showed higher numbers of procedures needed to overcome the learning curve (rho = 0.64, P < 0.001). Conclusions This study summarizes learning curves for open-, laparoscopic-, and robotic pancreatic surgery with different definitions, analysis methods, and confounding factors. A standardized reporting of learning curves and definition of phases (competency, proficiency, mastery) is desirable and proposed.
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Affiliation(s)
- P. C. Müller
- From the Department of Surgery, Clinic Beau-Site, Bern, Switzerland
| | - C. Kuemmerli
- Clarunis, University Center for Gastrointestinal and Liver Disorders, University Hospital Basel, Basel, Switzerland
| | - A. Cizmic
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - S. Sinz
- Department of General Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - P. Probst
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M. de Santibanes
- Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S. V. Shrikhande
- Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - C. Tschuor
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M. Loos
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - A. Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K. Z’graggen
- From the Department of Surgery, Clinic Beau-Site, Bern, Switzerland
| | - B. P. Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T. Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M. W. Büchler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - F. Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
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21
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Jacobsen MF, Konge L, Cour M, Sørensen RB, Park YS, Thomsen ASS. The learning curve of robot-assisted vitreoretinal surgery - A randomized trial in a simulated setting. Acta Ophthalmol 2021; 99:e1509-e1516. [PMID: 33650326 DOI: 10.1111/aos.14822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the learning curve of robot-assisted vitreoretinal surgery compared to manual surgery in a simulated setting. METHODS The study was designed as a randomized controlled longitudinal study. Eight ophthalmic trainees in the 1st or 2nd year of their specialization were included. The participants were randomized to either manual or robot-assisted surgery. Participants completed repetitions of a test consisting of three vitreoretinal modules on the Eyesi virtual reality simulator. The primary outcome measure was time to learning curve plateau (minutes) for total test score. The secondary outcome measures were instrument movement (mm), tissue treatment (mm2 ) and time with instruments inserted (seconds). RESULTS There was no significant difference in time to learning curve plateau for robot-assisted vitreoretinal surgery compared to manual. Robot-assisted vitreoretinal surgery was associated with less instrument movements (i.e. improved precision), -0.91 standard deviation (SD) units (p < 0.001). Furthermore, robot-assisted vitreoretinal surgery was associated with less tissue damage when compared to manual surgery, -0.94 SD units (p = 0.002). Lastly, robot-assisted vitreoretinal surgery was slower than manual surgery, 0.93 SD units (p < 0.001). CONCLUSIONS There was no significant difference between the lengths of the learning curves for robot-assisted vitreoretinal surgery compared to manual surgery. Robot-assisted vitreoretinal surgery was more precise, associated with less tissue damage, and slower.
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Affiliation(s)
- Mads F. Jacobsen
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Copenhagen Academy for Medical Education and Simulation Centre for HR Copenhagen Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation Centre for HR Copenhagen Denmark
| | - Morten Cour
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
| | - Rasmus B. Sørensen
- Copenhagen Academy for Medical Education and Simulation Centre for HR Copenhagen Denmark
| | - Yoon Soo Park
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Ann Sofia S. Thomsen
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Copenhagen Academy for Medical Education and Simulation Centre for HR Copenhagen Denmark
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22
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Kanitra JJ, Khogali-Jakary N, Gambhir SB, Davis AT, Hollis M, Moon C, Gupta R, Haan PS, Anderson C, Collier D, Henry D, Kavuturu S. Transference of skills in robotic vs. laparoscopic simulation: a randomized controlled trial. BMC Surg 2021; 21:379. [PMID: 34711220 PMCID: PMC8554974 DOI: 10.1186/s12893-021-01385-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 10/18/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Elucidating how robotic skills are best obtained will enable surgeons to best develop future robotic training programs. We perform a randomized controlled trial to assess the performance of robotic compared to laparoscopic surgery, transference of pre-existing skills between the two modalities, and to assess the learning curve between the two using novice medical students. METHODS Forty students were randomized into either Group A or B. Students practiced and were tested on a peg transfer task in either a laparoscopic simulator (LS) and robotic simulator (RS) in a pre-defined order. Performance, transference of skills and learning curve were assessed for each modality. Additionally, a fatigue questionnaire was issued. RESULTS There was no significant difference between overall laparoscopic scores (219 ± 19) and robotic scores (227 ± 23) (p = 0.065). Prior laparoscopic skills performed significantly better on robotic testing (236 ± 12) than without laparoscopic skills (216 ± 28) (p = 0.008). There was no significant difference in scores between students with prior robotic skills (223 ± 16) than without robotic skills (215 ± 22) (p = 0.162). Students reported no difference in fatigue between RS and LS. The learning curve plateaus at similar times between both modalities. CONCLUSION Novice medical students with laparoscopic skills performed better on a RS test than students without laparoscopic training, suggesting a transference of skills from laparoscopic to robotic surgery. These results suggest laparoscopic training may be sufficient in general surgery residencies as the skills transfer to robotic if used post-residency.
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Affiliation(s)
- John J Kanitra
- Department of Surgery, Ascension St. John Hospital, Detroit, MI, 48236, USA
| | - Nashwa Khogali-Jakary
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Sahil B Gambhir
- Department of General Surgery, University of California, Irvine Medical Center, Orange, CA, 92868, USA
| | - Alan T Davis
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Michael Hollis
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Caroline Moon
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Rama Gupta
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Pamela S Haan
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Cheryl Anderson
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Deborah Collier
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - David Henry
- Montefiore Medical Center, Bronx, NY, 10467, USA
| | - Srinivas Kavuturu
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA.
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Hague CM, Merrill SB. Integration of Robotics in Urology Residency Programs: an Unchecked Technological Revolution. Curr Urol Rep 2021; 22:47. [PMID: 34532784 DOI: 10.1007/s11934-021-01062-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW To review the integration of robotics in urology residency programs and evaluate how it has impacted a graduates' level of surgical competence. RECENT FINDINGS Surgical technique training has shown a dramatic shift towards robotics with the most profound occurring in oncology. However, integration of robotics is not uniform across programs nor even among residents themselves. Robotics require graduates to garner a broader skill set within the same prescribed training time. Unfortunately, in this modern era, graduates are feeling more ill-equipped to start independent practice and show an increased need to pursue fellowship training to achieve technical proficiency. The dissemination of robotics in residency programs has gone unchecked. Modulating existing training structures through (1) development of procedure- and surgical technique-specific target metrics for graduation and (2) integration of a formalized robotic curriculum may improve the overall quality and outcome of the educational experience.
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Affiliation(s)
- Christian M Hague
- Department of Surgery, Division of Urology, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Suzanne B Merrill
- Department of Surgery, Division of Urology, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
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24
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Grivas N, Zachos I, Georgiadis G, Karavitakis M, Tzortzis V, Mamoulakis C. Learning curves in laparoscopic and robot-assisted prostate surgery: a systematic search and review. World J Urol 2021; 40:929-949. [PMID: 34480591 DOI: 10.1007/s00345-021-03815-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/17/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To perform a systematic search and review of the available literature on the learning curves (LCs) in laparoscopic and robot-assisted prostate surgery. METHODS Medline was systematically searched from 1946 to January 2021 to detect all studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, reporting on the LC in laparoscopic radical prostatectomy (LRP), laparoscopic simple prostatectomy (LSP), robot-assisted radical prostatectomy (RARP) and robot-assisted simple prostatectomy (RSP). RESULTS In total, 47 studies were included for qualitative synthesis evaluating a single technique (LRP, RARP, LSP, RSP; 45 studies) or two techniques (LRP and RARP; 2 studies). All studies evaluated outcomes on real patients. RARP was the most widely investigated technique (30 studies), followed by LRP (17 studies), LSP (1 study), and RSP (1 study). In LRP, the reported LC based on operative time; estimated blood loss; length of hospital stay; positive surgical margin; biochemical recurrence; overall complication rate; and urinary continence rate ranged 40-250, 80-250, 58-200, 50-350, 110-350, 55-250, 70-350 cases, respectively. In RARP, the corresponding ranges were 16-300, 20-300, 25-200, 50-400, 40-100, 20-250, 30-200, while LC for potency rates was 80-90 cases. CONCLUSIONS The definition of LC for laparoscopic and robot-assisted prostate surgery is not well defined with various metrics used among studies. Nevertheless, LCs appear to be steep and continuous. Implementation of training programs/standardization of the techniques is necessary to improve outcomes.
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Affiliation(s)
- Nikolaos Grivas
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Ioannis Zachos
- Department of Urology, University Hospital of Larissa, University of Thessaly, Medical School, Larissa, Greece
| | - Georgios Georgiadis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Vasilis Tzortzis
- Department of Urology, University Hospital of Larissa, University of Thessaly, Medical School, Larissa, Greece
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece.
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25
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Russ G, Ben Hamou A, Poirée S, Ghander C, Ménégaux F, Leenhardt L, Buffet C. Learning curve for radiofrequency ablation of benign thyroid nodules. Int J Hyperthermia 2021; 38:55-64. [PMID: 33491515 DOI: 10.1080/02656736.2021.1871974] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: To evaluate the effect of operator experience on the treatment outcomes of radiofrequency ablation (RFA) for benign thyroid nodules (BTN). Methods: Data from the 90 first RFA procedures of a single operator in treating benign thyroid nodules were prospectively collected and retrospectively analyzed. Patients were divided into 3 groups according to their chronological treatment rank: patients 1-30 (G1), 31-60 (G2) and 61-90 (G3). Clinical symptoms, volume reduction ratio (VRR), technique efficacy (TE) defined as a VRR > 50% and ablation ratio (AR) were compared between the three groups at 6 months follow-up. All complications and side effects were recorded. Results: No significant difference was observed in improvement of clinical symptoms after the RFA procedure between the three groups, with higher satisfaction however for pressure symptoms than for esthetic complaints (complete resolution 87.5% and 52.6%, respectively). In groups 1, 2 and 3, TE was 60%, 93.3%, 76.7%, VRR 54%, 65%, 60% and AR 13.1%, 34%, 34.6%, respectively. Thus, all ultrasound efficacy parameters (TE, VRR, AR) improved significantly between G1 and G2, with no difference between G2 and G3. Solely did AR improve in nodules ≤ 30 mL between G2 and G3 to reach a median value of 94.4% in G3 versus 57.1% in G2 and 13.7% in G1. Maximum values of TE and VRR (95.6% and 68%, respectively) were seen in nodules ≤ 30 mL in G2 at 6 months follow-up, with no improvement in G3 (84.2% and 63%, respectively). Both baseline volume and energy per volume were independently associated with VRR and AR. Three minor complications were recorded which all recovered totally after conservative treatment. Conclusion: There was a measurable learning curve in RFA for benign thyroid nodules regarding efficacy until 90 patients. VRR and AR can be used as proficiency markers. Only three transient complications occurred confirming the safety of the procedure.
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Affiliation(s)
- Gilles Russ
- Thyroid and Endocrine Tumors Department, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Centre of Pathology and Radiology, Paris, France.,Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | | | - Sylvain Poirée
- Thyroid and Endocrine Tumors Department, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Cécile Ghander
- Thyroid and Endocrine Tumors Department, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Fabrice Ménégaux
- Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.,Service de Chirurgie Générale et Digestive, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Laurence Leenhardt
- Thyroid and Endocrine Tumors Department, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Camille Buffet
- Thyroid and Endocrine Tumors Department, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Unité Thyroïde-Tumeurs endocrine, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
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26
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Gómez Hernández MT, Fuentes Gago M, Novoa Valentín N, Rodríguez Alvarado I, Jiménez López MF. Robotic anatomical lung resections: Analysis of the learning curve. Cir Esp 2021; 99:421-427. [PMID: 34099400 DOI: 10.1016/j.cireng.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/30/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Robotic surgery has become a safe and effective approach for the treatment of pulmonary surgical pathology. However, the adoption of new surgical techniques requires the evaluation of the learning curve. The objective of this study is to analyze the learning curve of robotic anatomical lung resections. METHODS Retrospective analysis of all robotic anatomical lung resections performed by the same surgeon between June 2018 and March 2020. The learning curve was evaluated using CUSUM charts to estimate trend changes in surgical time, surgical failure and the occurrence of post-operative cardiorespiratory complications throughout the sequence of cases. RESULTS The study included a total of 73 cases. The median duration of all complications was 120 min (interquartile range: 90-150 min), the prevalence of surgical failure was 23.29%, while 4/73 patients had any postoperative cardiorespiratory complication. Based on the CUSUM analysis, the learning curve was divided into 3 different phases: phase i (from the first to the 14th intervention), phase ii (between the 15th and 30th intervention) and phase iii (from the 31st intervention). CONCLUSIONS The learning curve for robotic anatomical lung resections can be divided into 3 phases. The technical competence that guarantees satisfactory perioperative outcomes was achived in phase iii from the 31st intervention.
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Affiliation(s)
| | - Marta Fuentes Gago
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Nuria Novoa Valentín
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain
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27
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Cristofari H, Jung MK, Niclauss N, Toso C, Kloetzer L. Teaching and learning robotic surgery at the dual console: a video-based qualitative analysis. J Robot Surg 2021; 16:169-178. [PMID: 33723791 PMCID: PMC8863707 DOI: 10.1007/s11701-021-01224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/04/2021] [Indexed: 11/29/2022]
Abstract
Robotic-assisted surgery (RAS) involves training processes and challenges that differ from open or laparoscopic surgery, particularly regarding the possibilities of observation and embodied guidance. The video recording and the dual-console system creates a potential opportunity for participation. Our research, conducted within the department of visceral surgery of a big Swiss, public, academic hospital, uses a methodology based on the co-analysis of video recordings with surgeons in self-confrontation interviews, to investigate the teaching activity of the lead surgeon supervising a surgeon in training at the dual console. Three short sequences have been selected for the paper. Our analysis highlights the skills-in-construction of the surgeon in training regarding communication with the operating team, fluency of working with three hands, and awareness of the whole operating site. It also shows the divergent necessities of enabling verbalization for professional training, while ensuring a quiet and efficient environment for medical performance. To balance these requirements, we argue that dedicated briefing and debriefing sessions may be particularly effective; we also suggest that the self-confrontation video technique may be valuable to support the verbalization on both the mentor’s and the trainee’s side during such debriefing, and to enhance the mentor’s reflexivity regarding didactic choices.
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Affiliation(s)
- Hélène Cristofari
- Institute of Psychology and Education, University of Neuchâtel, Neuchâtel, Switzerland
| | - Minoa Karin Jung
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Nadja Niclauss
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Christian Toso
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laure Kloetzer
- Institute of Psychology and Education, University of Neuchâtel, Neuchâtel, Switzerland.
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28
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Liang TJ, Tsai CY, Liu SI, Chen IS. Multidimensional Analyses of the Learning Curve of Endoscopic Thyroidectomy. World J Surg 2021; 45:1446-1456. [PMID: 33512565 DOI: 10.1007/s00268-021-05953-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Endoscopic thyroidectomy has comparable surgical outcomes and superior cosmetic satisfaction to open thyroidectomy. However, steep learning curve is a concern. This study evaluated the learning curve of endoscopic thyroidectomy using various parameters and statistical methods. METHODS A total of 90 consecutive patients who underwent endoscopic thyroidectomy using bilateral axillo-breast approach (BABA) between March 2016 and April 2020 were enrolled. Operative time, postoperative drainage amount, and blood loss were assessed by cumulative sum (CUSUM) analysis and moving average to evaluate the learning curve. RESULTS Using the CUSUM analysis, the peak point of both operative time and drainage amount occurred at the 30th case. No clear single peak was identified in the CUSUM plot for blood loss. The moving average also showed significant reduction in operative time and drainage amount after, approximately, the first 30 cases. The blood loss decreased after the 25th case. We therefore divided the patients into 2 phases: phase 1 (1-30 cases) and phase 2 (31-90 cases). The operative time, drainage amount, and blood loss decreased significantly in the phase 2 compared with phase 1. Lower pain score in first postoperative day and shorter hospital stay were also observed in the phase 2. Although the reduction in transient hypoparathyroidism did not reach statistical significance, no permanent hypoparathyroidism was noted in the phase 2. CONCLUSIONS The learning curve for endoscopic thyroidectomy is approximately 30 cases. Aside from the operative time, drainage amount may also serve as a surrogate for the learning curve evaluation.
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Affiliation(s)
- Tsung-Jung Liang
- Division of General Surgery, Department of Surgery, Zuoying District, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Kaohsiung, 81362, Taiwan.,School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan
| | - Chung-Yu Tsai
- Division of General Surgery, Department of Surgery, Zuoying District, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Kaohsiung, 81362, Taiwan
| | - Shiuh-Inn Liu
- Division of General Surgery, Department of Surgery, Zuoying District, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Kaohsiung, 81362, Taiwan.,School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan
| | - I-Shu Chen
- Division of General Surgery, Department of Surgery, Zuoying District, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Kaohsiung, 81362, Taiwan.
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29
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Gualtieri T, Verzeletti V, Ferrari M, Perotti P, Morello R, Taboni S, Palumbo G, Ravanelli M, Rampinelli V, Mattavelli D, Paderno A, Buffoli B, Rodella LF, Nicolai P, Deganello A. A new landmark for lingual artery identification during transoral surgery: Anatomic-radiologic study. Head Neck 2021; 43:1487-1498. [PMID: 33496052 DOI: 10.1002/hed.26606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 12/02/2020] [Accepted: 12/30/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A landmark for the identification of the lingual artery (LA) through a transoral perspective can provide surgeons with an easy method to prevent and manage intraoperative bleeding during transoral approach to the base of tongue (BOT). METHODS Thirteen tongue and five head and neck specimens were dissected to identify and assess the reliability of the lingual point (LP) as a new landmark for the LA at BOT. The pathway of 42 LAs was radiologically evaluated; axial depth and vertical offset were measured for each LA. RESULTS Dissection study: a description of LP is provided; the LA was easily identified in all specimens (36/36 sides) using LP as a landmark. Radiologic study: the mean depth of the LA was 4.2 mm, the mean vertical offset was 1.3 mm. CONCLUSIONS LP is a simple and reliable landmark for identification of the LA, potentially helping surgeons to prevent and manage intraoperative bleeding.
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Affiliation(s)
- Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vincenzo Verzeletti
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Pietro Perotti
- Department of Otorhinolaryngology - Head and Neck Surgery, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Riccardo Morello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, ASST Cremona - Ospedale di Cremona, Cremona, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Giovanni Palumbo
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Fabrizio Rodella
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Proietti F, La Regina D, Pini R, Di Giuseppe M, Cianfarani A, Mongelli F. Learning curve of robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias. Surg Endosc 2020; 35:6643-6649. [PMID: 33258030 DOI: 10.1007/s00464-020-08165-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/15/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Learning curves describe the rate of performance improvements according to the surgeon's caseload, followed by a plateau where limited additional improvements are observed. The aim of this study was to evaluate the learning curve for robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias in surgeons already experienced in laparoscopic TAPP. METHODS The study was approved by local ethic committee. Male patients undergoing rTAPP for inguinal hernia from October 2017 to December 2019 at the Bellinzona Regional Hospital were selected from a prospective database. Demographic and clinical data, including operative time, conversion to laparoscopic or open surgery, intra- and postoperative complications were collected and analyzed. RESULTS Over the study period, 170 rTAPP were performed by three surgeons in 132 patients, and mean age was 60.1 ± 13.7 years. The cumulative summation (CUSUM) test showed a significant operative time reduction after the 43rd operation, once the 90% proficiency on the logarithmic tendency line was achieved. The corrected operative time resulted 71.1 ± 22.0 vs. 60.8 ± 13.5 min during and after the learning curve (p = 0.011). Only one intraoperative complication occurred during the learning curve and required an orchiectomy. Postoperatively, three complications (one seroma, one hematoma, and one mesh infection) required invasive interventions during the learning curve, while no cases were recorded after it (p = 0.312). CONCLUSION Our study shows that the rTAPP, performed by experienced laparoscopists, has a learning curve which requires 43 inguinal hernia repairs to achieve 90% proficiency and to significantly reduce the operative time.
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Affiliation(s)
- Francesco Proietti
- Surgery, Ospedale Regionale di Lugano, via Tesserete 46, 6900, Lugano, Switzerland.
| | - Davide La Regina
- Surgery, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Ramon Pini
- Surgery, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Matteo Di Giuseppe
- Surgery, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Agnese Cianfarani
- Surgery, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Francesco Mongelli
- Surgery, Ospedale Regionale di Lugano, via Tesserete 46, 6900, Lugano, Switzerland
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Robotic surgery versus open surgery for thyroid neoplasms: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2020; 146:3297-3312. [PMID: 33108513 DOI: 10.1007/s00432-020-03418-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/01/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Robotic surgical system has been gradually applied in thyroid neoplasms as a novel treatment for years, with presenting some superiorities as well as limitations. To compare the effectiveness and safety of robotic surgery with open surgery for the patients with thyroid neoplasms, this review was conducted METHODS: We performed electronic search in CENTRAL, MEDLINE, EMBASE, CNKI, CBM, Opengray, and Sciencepaper Online databases and manual search in specific online databases and according to the reference list of relevant papers to get all the studies that compared the effectiveness and safety of robotic surgery with that of open surgery for patients with thyroid neoplasms. Last update was conducted in March 2020. Randomized-controlled trials, case-control studies, cohort studies, and cross-sectional surveys were all included. RESULTS In this review, 59 studies were included: two RCTs, 15 NRSs, 40 cohort studies, and two cross-sectional studies. Robotic surgery was found to be associated with longer operative duration, less retrieved lymph nodes, higher postoperative thyroglobulin before radioactive iodine ablation, similar complication incidence but less blood loss, better functional recovery, and higher cosmetic satisfaction compared to open surgery. CONCLUSIONS Robotic surgery is a safe and feasible approach with remarkable superiority in reducing intraoperative damage and improving patients' quality of life compared to open surgery for thyroid neoplasms. Meanwhile, this procedure is also associated with long operative duration, insufficient removal of neck lymph nodes, which need to be given careful consideration.
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Abstract
INTRODUCTION Robotic surgery has become a safe and effective approach for the treatment of pulmonary surgical pathology. However, the adoption of new surgical techniques requires the evaluation of the learning curve. The objective of this study is to analyze the learning curve of robotic anatomical lung resections. METHODS Retrospective analysis of all robotic anatomical lung resections performed by the same surgeon between June 2018 and March 2020. The learning curve was evaluated using CUSUM charts to estimate trend changes in surgical time, surgical failure and the occurrence of post-operative cardiorespiratory complications throughout the sequence of cases. RESULTS The study included a total of 73 cases. The median duration of all complications was 120min (interquartile range: 90-150min), the prevalence of surgical failure was 23.29%, while 4/73 patients had any postoperative cardiorespiratory complication. Based on the CUSUM analysis, the learning curve was divided into 3 different phases: phase i (from the first to the 14th intervention), phase ii (between the 15th and 30th intervention) and phase iii (from the 31st intervention). CONCLUSIONS The learning curve for robotic anatomical lung resections can be divided into 3 phases. The technical competence that guarantees satisfactory perioperative outcomes was achived in phase iii from the 31st intervention.
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Vasudevan MK, Isaac JHR, Sadanand V, Muniyandi M. Novel virtual reality based training system for fine motor skills: Towards developing a robotic surgery training system. Int J Med Robot 2020; 16:1-14. [PMID: 32976695 DOI: 10.1002/rcs.2173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/20/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Training surgeons to use surgical robots are becoming part of surgical training curricula. We propose a novel method of training fine-motor skills such as Microscopic Selection Task (MST) for robot-assisted surgery using virtual reality (VR) with objective quantification of performance. We also introduce vibrotactile feedback (VTFB) to study its impact on training performance. METHODS We use a VR-based environment to perform MST with varying degrees of difficulties. Using a well-known human-computer interaction paradigm and incorporating VTFB, we quantify the performance: speed, precision and accuracy. RESULTS MST with VTFB showed statistically significant improvement in performance metrics leading to faster completion of MST with higher precision and accuracy compared to that without VTFB. DISCUSSION The addition of VTFB to VR-based training for robot-assisted surgeries may improve performance outcomes in real robotic surgery. VTFB, along with proposed performance metrics, can be used in training curricula for robot-assisted surgeries.
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Affiliation(s)
- Madhan Kumar Vasudevan
- Touch Lab, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Joseph H R Isaac
- Touch Lab, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India.,Reconfigurable Intelligent Systems Engineering (RISE) Lab, Department of Computer Science and Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Venkatraman Sadanand
- Department of Neurosurgery, Loma Linda University Health System, Loma Linda, California, USA
| | - Manivannan Muniyandi
- Touch Lab, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
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Correlation between operative time and crowd-sourced skills assessment for robotic bariatric surgery. Surg Endosc 2020; 35:5303-5309. [PMID: 32970207 DOI: 10.1007/s00464-020-08019-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Operative time has been traditionally used as a proxy for surgical skill and is commonly utilized to measure the learning curve, assuming that faster operations indicate a more skilled surgeon. The Global Evaluative Assessment of Robotic Skills (GEARS) rubric is a validated Likert scale for evaluating technical skill. We hypothesize that operative time will not correlate with the GEARS score. METHODS Patients undergoing elective robotic sleeve gastrectomy at a single bariatric center of excellence hospital from January 2019 to March 2020 were captured in a prospectively maintained database. For step-specific scoring, videos were broken down into three steps: ligation of short gastric vessels, gastric transection, and oversewing the staple line. Overall and step-specific GEARS scores were assigned by crowd-sourced evaluators. Correlation between operative time and GEARS score was assessed with linear regression and calculation of the R2 statistic. RESULTS Sixty-eight patients were included in the study, with a mean operative time of 112 ± 27.4 min. The mean GEARS score was 20.1 ± 0.81. Mean scores for the GEARS subcomponents were: bimanual dexterity 4.06 ± 0.17; depth perception 3.96 ± 0.24; efficiency 3.82 ± 0.19; force sensitivity 4.06 ± 0.20; robotic control 4.16 ± 0.21. Operative time and overall score showed no correlation (R2 = 0.0146, p = 0.326). Step-specific times and scores showed weak correlation for gastric transection (R2 = 0.0737, p = 0.028) and no correlation for ligation of short gastric vessels (R2 = 0.0262, p = 0.209) or oversewing the staple line (R2 = 0.0142, p = 0.344). CONCLUSIONS Operative time and crowd-sourced GEARS score were not correlated. Operative time and GEARS scores measure different performance characteristics, and future studies should consider using both a validated skills assessment tool and operative time for a more complete evaluation of skill.
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Kwon H. Impact of bedside assistant on outcomes of robotic thyroid surgery: A STROBE-compliant retrospective case-control study. Medicine (Baltimore) 2020; 99:e22133. [PMID: 32899100 PMCID: PMC7478536 DOI: 10.1097/md.0000000000022133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The importance of bedside assistants has been well established in various robotic procedures. However, the effect of assistants on the surgical outcomes of thyroid surgery remains unclear. We investigated the effects of a dedicated robot assistant (DRA) in robotic thyroidectomy. We also evaluated the learning curve of the DRA.Between January 2016 and December 2019, 191 patients underwent robotic total thyroidectomy, all of which were performed by a single surgeon. The DRA participated in 93 cases, while non-dedicated assistants (NRAs) helped with 98 cases. Demographic data, pathologic data, operative times, and postoperative complications were recorded and analyzed.Robotic thyroidectomy was successful in all 191 patients, and none required conversion to the conventional open procedure. Mean operative time was shorter in the DRA group than in the NRA group (183.2 ± 33.6 minutes vs 203.1 ± 37.9 minutes; P < .001). There were no significant differences in terms of sex distribution, age, preoperative serum thyroid stimulating hormone level, or pathologic characteristics between the groups. Cumulative summation analysis showed that it took 36 cases for the DRA to significantly reduce operative time. Mean operative time decreased significantly in the subgroup including the 37th to the 93rd DRA cases compared with the subgroup including only the first 36 DRA cases (199.7 ± 37.3 minutes vs 172.8 ± 26.4 minutes; P < .001). NRA group showed no definite decrease of operation time, which indicated that the NRAs did not significantly deviate from the mean performance.Increased experience of the bedside assistant reduced operative times in the robotic thyroidectomy. Assistant training should be considered as a component of robotic surgery training programs.
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Kunert W, Storz P, Dietz N, Axt S, Falch C, Kirschniak A, Wilhelm P. Learning curves, potential and speed in training of laparoscopic skills: a randomised comparative study in a box trainer. Surg Endosc 2020; 35:3303-3312. [PMID: 32642847 PMCID: PMC8195927 DOI: 10.1007/s00464-020-07768-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023]
Abstract
Background The effectiveness of practical surgical training is characterised by an inherent learning curve. Decisive are individual initial starting capabilities, learning speed, ideal learning plateaus, and resulting learning potentials. The quantification of learning curves requires reproducible tasks with varied levels of difficulty. The hypothesis of this study is that the use of three-dimensional (3D) vision is more advantageous than two-dimensional vision (2D) for the learning curve in laparoscopic training. Methods Forty laparoscopy novices were recruited and randomised to a 2D Group and a 3D Group. A laparoscopy box trainer with two standardised tasks was used for training of surgical tasks. Task 1 was a positioning task, while Task 2 called for laparoscopic knotting as a more complex process. Each task was repeated at least ten times. Performance time and the number of predefined errors were recorded. 2D performance after 3D training was assessed in an additional final 2D cycle undertaken by the 3D Group. Results The calculated learning plateaus of both performance times and errors were lower for 3D. Independent of the vision mode the learning curves were smoother (exponential decay) and efficiency was learned faster than precision. The learning potentials varied widely depending on the corresponding initial values and learning plateaus. The final 2D performance time of the 3D-trained group was not significantly better than that of the 2D Group. The final 2D error numbers were similar for all groups. Conclusions Stereoscopic vision can speed up laparoscopic training. The 3D learning curves resulted in better precision and efficiency. The 3D-trained group did not show inferior performance in the final 2D cycle. Consequently, we encourage the training of surgical competences like suturing and knotting under 3D vision, even if it is not available in clinical routine.
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Affiliation(s)
- Wolfgang Kunert
- Department of General, Visceral and Transplant Surgery, Surgical Technology and Training, Tuebingen University Hospital, Waldhoernlestrasse 22, 72072, Tuebingen, Germany
| | - Pirmin Storz
- Department of General, Visceral and Transplant Surgery, Surgical Technology and Training, Tuebingen University Hospital, Waldhoernlestrasse 22, 72072, Tuebingen, Germany.,Clinic for General, Visceral and Pediatric Surgery, Duesseldorf University Hospital, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Nicolaus Dietz
- Department of General, Visceral and Transplant Surgery, Surgical Technology and Training, Tuebingen University Hospital, Waldhoernlestrasse 22, 72072, Tuebingen, Germany.,Evangelisches Krankenhaus Oberhausen, Virchowstr. 20, 46047, Oberhausen, Germany
| | - Steffen Axt
- Department of General, Visceral and Transplant Surgery, Surgical Technology and Training, Tuebingen University Hospital, Waldhoernlestrasse 22, 72072, Tuebingen, Germany
| | - Claudius Falch
- Department of General, Visceral and Transplant Surgery, Surgical Technology and Training, Tuebingen University Hospital, Waldhoernlestrasse 22, 72072, Tuebingen, Germany
| | - Andreas Kirschniak
- Department of General, Visceral and Transplant Surgery, Surgical Technology and Training, Tuebingen University Hospital, Waldhoernlestrasse 22, 72072, Tuebingen, Germany.
| | - Peter Wilhelm
- Department of General, Visceral and Transplant Surgery, Surgical Technology and Training, Tuebingen University Hospital, Waldhoernlestrasse 22, 72072, Tuebingen, Germany
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Shen D, Du S, Huang Q, Gao Y, Fan Y, Gu L, Liu K, Peng C, Xuan Y, Li P, Li H, Ma X, Zhang X, Wang B. A modified sequential vascular control strategy in robot-assisted level III-IV inferior vena cava thrombectomy: initial series mimicking the open 'milking' technique principle. BJU Int 2020; 126:447-456. [PMID: 32330369 DOI: 10.1111/bju.15094] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To introduce a modified sequential vascular control strategy, mimicking the open 'milking' technique principle, for the early release of the first porta hepatis (FPH) and to stop cardiopulmonary bypass (CPB) in level III-IV robot-assisted inferior vena cava (IVC) thrombectomy (RA-IVCTE). PATIENTS AND METHODS From November 2014 to June 2019, 27 patients with a level III-IV IVC tumour thrombus (IVCTT) underwent RA-IVCTE in our department. The modified sequential control strategy was used in 12 cases. Previously, we released the FPH after the thrombus was resected and the IVC was closed completely, and CPB was stopped at the end of surgery (15 patients). Presently, using our modified strategy, we place another tourniquet inferior to the second porta hepatis (SPH) once the proximal thrombus is removed from the IVC below the SPH. Then, we suture the right atrium and perform early release of the FPH, and stop CPB. Finally, tumour thrombectomy, vascular reconstruction, and radical nephrectomy are performed. RESULTS Compared with the previous strategy, the modified steps resulted in a shorter median FPH clamping (19 vs 47 min, P < 0.001) and CPB times (60 vs 87 min, P < 0.05); a lower rate of Grade II-IV perioperative complications (25% vs 60%, P < 0.05); and better postoperative hepatorenal and coagulation function, including better median serum alanine aminotransferase (172.7 vs 465.4 U/L, P < 0.001), aspartate aminotransferase (282.4 vs 759.8 U/L, P < 0.001), creatinine (113.4 vs 295 μmol/L, P < 0.01), blood urea nitrogen (7.3 vs 16.7 mmol/L, P < 0.01), and D-dimer (5.9 vs 20 mg/L, P < 0.001) levels. CONCLUSION With the early release of the FPH and stopping CPB, the modified sequential vascular control strategy in level III-IV RA-IVCTE reduced the perioperative risk for selected patients and improved the feasibility and safety of the surgery. We would recommend this approach to other centres that plan to develop robotic surgery for renal cell carcinoma with level III-IV IVCTT in the future.
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Affiliation(s)
- Donglai Shen
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Songliang Du
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Qingbo Huang
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Yu Gao
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Yang Fan
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Kan Liu
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Cheng Peng
- Department of Urology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yundong Xuan
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Pin Li
- Department of Pediatric Urology, Bayi Children's Hospital Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Xin Ma
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
| | - Baojun Wang
- Department of Urology/State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing, China
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Shen D, Wang H, Wang C, Huang Q, Li S, Wu S, Xuan Y, Gong H, Li H, Ma X, Wang B, Zhang X. Cumulative Sum Analysis of the Operator Learning Curve for Robot-Assisted Mayo Clinic Level I-IV Inferior Vena Cava Thrombectomy Associated with Renal Carcinoma: A Study of 120 Cases at a Single Center. Med Sci Monit 2020; 26:e922987. [PMID: 32107362 PMCID: PMC7063847 DOI: 10.12659/msm.922987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background This study aimed to use cumulative sum analysis of the operator learning curve for robot-assisted Mayo Clinic level I–IV inferior vena cava (IVC) thrombectomy associated with renal carcinoma, and describes the development of an optimized operative procedure at a single center. Material/Methods A retrospective study included 120 patients with Mayo Clinic level I–IV IVC thrombus who underwent robotic surgery between 2013 and 2018. Points in the learning curve were identified using cumulative sum analysis, and their impact was assessed by multiple regression analysis. Perioperative indicators analyzed included operative time, estimated blood loss, early complications, and the 90-day progression rate. Results Cumulative sum analysis identified three phases in the learning curve of robot-assisted IVC thrombectomy. The median operative time decreased from 265 min (range, 212–401 min) to 207 min (range, 146–276 min) (p=0.003), the median estimated blood loss decreased from 775 ml (range, 413–1500 ml) to 300 ml (range, 163–813 ml) (p=0.006), and the early complication rate decreased from 52.5% to 15.0% (p<0.001). Multivariate analysis showed that for an initial 40 cases and a further 80 cases, the learning phase, the affected side, the Mayo Clinic level, and the surgical method were independent factors that affected operative time, estimated blood loss, and the rate of early complications. Conclusions Experience from an initial 40 cases and a further 80 cases of Mayo Clinic level I–IV IVC thrombectomy associated with renal carcinoma were found to provide acceptable surgical and clinical outcomes.
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Affiliation(s)
- Donglai Shen
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Hanfeng Wang
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Chenfeng Wang
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Qingbo Huang
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Shichao Li
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Shengpan Wu
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Yundong Xuan
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Huijie Gong
- Department of Urology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Hongzhao Li
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Xin Ma
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Baojun Wang
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Xu Zhang
- Department of Urology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
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Aydemir CA, Arısan V. Accuracy of dental implant placement via dynamic navigation or the freehand method: A split-mouth randomized controlled clinical trial. Clin Oral Implants Res 2019; 31:255-263. [PMID: 31829457 DOI: 10.1111/clr.13563] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this split-mouth randomized controlled clinical trial was to compare the deviations of planned and placed implants placed by the assistance of a micron tracker-based dynamic navigation device or freehand methods. MATERIAL AND METHODS A thermoplastic fiducial marker was adapted on the anterior teeth, and cone-beam computerized tomography was used for imaging. A minimum of one implant was planned for each side of the posterior maxilla, and the dynamic navigation device or freehand method was randomly used for surgical insertion. Deviations were measured by matching the planning data with a final CBCT image. Linear deviations (mm) between the planned and placed implants were the primary outcome. The results were analysed by generalized linear mixed models (p < .05). (NCT03471208). RESULTS A total of 92 implants were placed to 32 volunteers, and 86 implants were included in the final analysis. For the linear deviations, mean of differences (Δ) was 0.72mm (Standard deviation (SD): 0.26); (95% Confidence interval (CI): 0.39-1.02) in the shoulder of the implants (p < .001) and 0.69mm (SD: 0.36); (95% CI: 0.19-1.19) in the tip of the implants (p < .001). For the angular deviations, Δ was 5.33° (SD: 1.63); (95% CI: 7.17-3.48); (p < .001). CONCLUSIONS The navigation technique can be used to transfer virtual implant planning to the patient's jaw with increased accuracy.
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Affiliation(s)
- Ceyda Aktolun Aydemir
- Department of Oral Implantology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Volkan Arısan
- Department of Oral Implantology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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Leijte E, de Blaauw I, Van Workum F, Rosman C, Botden S. Robot assisted versus laparoscopic suturing learning curve in a simulated setting. Surg Endosc 2019; 34:3679-3689. [PMID: 31754849 PMCID: PMC7326898 DOI: 10.1007/s00464-019-07263-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022]
Abstract
Background Compared to conventional laparoscopy, robot assisted surgery is expected to have most potential in difficult areas and demanding technical skills like minimally invasive suturing. This study was performed to identify the differences in the learning curves of laparoscopic versus robot assisted suturing. Method Novice participants performed three suturing tasks on the EoSim laparoscopic augmented reality simulator or the RobotiX robot assisted virtual reality simulator. Each participant performed an intracorporeal suturing task, a tilted plane needle transfer task and an anastomosis needle transfer task. To complete the learning curve, all tasks were repeated up to twenty repetitions or until a time plateau was reached. Clinically relevant and comparable parameters regarding time, movements and safety were recorded. Intracorporeal suturing time and cumulative sum analysis was used to compare the learning curves and phases. Results Seventeen participants completed the learning curve laparoscopically and 30 robot assisted. Median first knot suturing time was 611 s (s) for laparoscopic versus 251 s for robot assisted (p < 0.001), and this was 324 s versus 165 (sixth knot, p < 0.001) and 257 s and 149 s (eleventh knot, p < 0.001) respectively on base of the found learning phases. The percentage of ‘adequate surgical knots’ was higher in the laparoscopic than in the robot assisted group. First knot: 71% versus 60%, sixth knot: 100% versus 83%, and eleventh knot: 100% versus 73%. When assessing the ‘instrument out of view’ parameter, the robot assisted group scored a median of 0% after repetition four. In the laparoscopic group, the instrument out of view increased from 3.1 to 3.9% (left) and from 3.0 to 4.1% (right) between the first and eleventh knot (p > 0.05). Conclusion The learning curve of minimally invasive suturing shows a shorter task time curve using robotic assistance compared to the laparoscopic curve. However, laparoscopic outcomes show good end results with rapid outcome improvement. Electronic supplementary material The online version of this article (10.1007/s00464-019-07263-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erik Leijte
- Department of Pediatric Surgery, Radboud University Medical Centre - Amalia Children's Hospital, Geert Grooteplein 10 Route 618, 6500HB, Nijmegen, The Netherlands.
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboud University Medical Centre - Amalia Children's Hospital, Geert Grooteplein 10 Route 618, 6500HB, Nijmegen, The Netherlands
| | - Frans Van Workum
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sanne Botden
- Department of Pediatric Surgery, Radboud University Medical Centre - Amalia Children's Hospital, Geert Grooteplein 10 Route 618, 6500HB, Nijmegen, The Netherlands
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Kim H, Kwon H, Lim W, Moon BI, Paik NS. Quantitative Assessment of the Learning Curve for Robotic Thyroid Surgery. J Clin Med 2019; 8:jcm8030402. [PMID: 30909509 PMCID: PMC6463185 DOI: 10.3390/jcm8030402] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/12/2019] [Accepted: 03/19/2019] [Indexed: 12/14/2022] Open
Abstract
With the increased utilization of robot thyroidectomy in recent years, surgical proficiency is the paramount consideration. However, there is no single perfect or ideal method for measuring surgical proficiency. In this study, we evaluated the learning curve of robotic thyroidectomy using various parameters. A total of 172 robotic total thyroidectomies were performed by a single surgeon between March 2014 and February 2018. Cumulative summation analysis revealed that it took 50 cases for the surgeon to significantly improve the operation time. Mean operation time was significantly shorter in the group that included the 51st to the 172nd case, than in the group that included only the first 50 cases (132.8 ± 27.7 min vs. 166.9 ± 29.5 min; p < 0.001). On the other hand, the surgeon was competent after the 75th case when postoperative transient hypoparathyroidism was used as the outcome measure. The incidence of hypoparathyroidism gradually decreased from 52.0%, for the first 75 cases, to 40.2% after the 76th case. These results indicated that the criteria used to assess proficiency greatly influenced the interpretation of the learning curve. Incorporation of the operation time, complications, and oncologic outcomes should be considered in learning curve assessment.
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Affiliation(s)
- HyunGoo Kim
- Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea.
| | - Hyungju Kwon
- Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea.
| | - Woosung Lim
- Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea.
| | - Byung-In Moon
- Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea.
| | - Nam Sun Paik
- Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea.
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