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Comanici M, Salmasi MY, Schulte KL, Raja SG, Attia RQ. Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons? J Card Surg 2022; 37:3776-3798. [PMID: 36098376 DOI: 10.1111/jocs.16925] [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: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We sought to assess the safety of training in cardiothoracic surgery comparing outcomes of cases performed by trainees versus fully trained surgeons. METHODS EmBase, Scopus, PubMed, and OVID MEDLINE were searched in August 2021 independently by two authors. A third author arbitrated decisions to resolve disagreements. Inclusion criteria were articles on cardiothoracic surgery reporting on outcomes for trainees. Studies were assessed for appropriateness as per CBEM criteria. Eight hundred and ninety-two results were obtained, 27 represented best evidence (2-meta-analyses, 1-RCT, and 24 retrospective cohort studies). RESULTS In all 474,160 operative outcomes were assessed for 434,535 coronary artery bypass grafting (CABG) (431,329 on-pump vs. 3206 off-pump), 3090 AVR, 1740 MVR/repair, 26,433 mixed, 3565 congenital, and 4797 thoracic procedures. In all 398,058 cases were performed by trainees and 75,943 by consultants. One hundred fifty-nine cases were indeterminate. There were no statistically significant differences in the patients' preoperative risk scores. All studies excluded extreme high-risk patients in emergency setting, patients with poor left ventricular function, and reoperation cases that were undertaken by consultants. There were no differences in cardiopulmonary bypass and clamp times for CABG. Times for valve replacement and repair cases were longer for trainees. There were no differences in the postoperative outcomes including perioperative myocardial infarction, resternotomy for bleeding, stroke, renal failure, intensive therapy unit length of stay, and total length of stay. One study reported no differences on angiographic graft patency at 1 year. There were no differences in in-hospital or midterm mortality out to 5-years. DISCUSSION Trainees can perform cardiothoracic surgery in dedicated high-volume units with outcomes comparable to those of fully trained surgeons.
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Affiliation(s)
- Maria Comanici
- Department of Cardiac Surgery, Harefield Hospital, London, UK.,Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, Galați, Romania
| | | | | | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, London, UK
| | - Rizwan Q Attia
- Department of Cardiac Surgery, Harefield Hospital, London, UK
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2
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Time Taken for Pulmonary Vein Management by Residents Performing Video-Assisted Thoracoscopic Surgical Lobectomy for Malignant Thoracic Diseases. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Videothoracoscopic lobectomy training in non-small cell lung cancer. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:199-205. [PMID: 32082853 DOI: 10.5606/tgkdc.dergisi.2019.16509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/31/2018] [Indexed: 12/25/2022]
Abstract
Background This study aims to evaluate the outcomes of video-assisted thoracoscopic surgery lobectomies performed by a training consultant or an experienced consultant. Methods The study included 103 patients (81 males, 22 females; mean age 59.6±9.5 years; range, 32 to 84 years) who underwent video-assisted thoracoscopic surgery lobectomy due to non-small cell lung cancer. The training consultant assisted on the same side with the experienced consultant during the operations of the experienced consultant. The experienced consultant observed in the operating room and provided advice from a distance during the first five operations of the training consultant. Comorbidities, postoperative complications, and mortality were evaluated. Results Patients" demographic characteristics, comorbidities, and postoperative complications were similar between the two surgeons (p>0.05). Operative time, incidence of prolonged air leak, and length of hospital stay were higher in procedures performed by the training consultant (p<0.05). There were no significant differences in rates of life-threatening complications or mortality. Conclusion Video-assisted thoracoscopic surgery lobectomy can be performed safely by surgeons in training. Effective training programs may produce outcomes comparable to those of experienced surgeons.
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Video-Assisted Thoracoscopic Lobectomy for Lung Cancer. Ann Thorac Surg 2019; 107:603-609. [DOI: 10.1016/j.athoracsur.2018.07.088] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/26/2018] [Accepted: 07/29/2018] [Indexed: 12/31/2022]
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Liu L, Mei J, He J, Gao S, Li S, He J, Huang Y, Xu S, Mao W, Tan Q, Chen C, Li X, Zhang Z, Jiang G, Xu L, Zhang L, Fu J, Li H, Wang Q, Liu D, Tan L, Zhou Q, Fu X, Jiang Z, Chen H, Fang W, Zhang X, Li Y, Tong T, Yu Z, Liu Y, Zhi X, Yan T, Zhang X, Demmy TL, Berry MF, Gutierrez Pérez AB, Cataneo D, Bille A, Licht P, Kocher GJ, Oncel M, Evman S, Jensen K, Bagan P, Embun R. Society for Translational Medicine expert consensus on training and certification standards for surgeons and assistants in minimally invasive surgery for lung cancer. J Thorac Dis 2018; 10:5666-5672. [PMID: 30505474 DOI: 10.21037/jtd.2018.08.72] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie He
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100000, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China.,Guangzhou Institute of Respiratory Disease & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510000, China
| | - Yunchao Huang
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital), Kunming 650000, China
| | - Shidong Xu
- Department of Thoracic surgery, Harbin Medical University Cancer Hospital, Harbin 150086, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310000, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, The Third Military Medical University, Chongqing 400042, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710000, China
| | - Zhu Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai 210000, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing 210009, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510000, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510000, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Beijing 100000, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200000, China
| | - Deruo Liu
- Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100000, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200000, China
| | - Qinghua Zhou
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhongmin Jiang
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200000, China.,Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200000, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200000, China
| | - Xun Zhang
- Tianjin Chest Hospital, Tianjin 300051, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450000, China
| | - Ti Tong
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130000, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110000, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100000, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100000, China
| | - Xingyi Zhang
- Department of Thoracic Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | | | - Daniele Cataneo
- Thoracic Surgery Division, Botucatu School of Medicine, São Paulo State University, São Paulo, Brazil
| | - Andrea Bille
- Department of Thoracic Surgery, Guys Hospital, London, UK
| | - Peter Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Gregor J Kocher
- Division of Thoracic Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Murat Oncel
- Department of Thoracic Surgery, Selcuk University Medical Faculty, Konya, Turkey
| | - Serdar Evman
- Sureyyapasa Training and Research Hospital, Istanbul, Turkey
| | - Katrine Jensen
- Department of Cardiothoracic Surgery 2152, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Patrick Bagan
- Centre Hospitalier Victor Dupouy, 69 rue du Lieutenant Colonel Prudhon, Argenteuil, France
| | - Raul Embun
- Thoracic Surgery Department, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
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Zhu Y, Jiang G. [Thinking on the Training of Uniportal Video-assisted Thoracic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:260-264. [PMID: 29587901 PMCID: PMC5973337 DOI: 10.3779/j.issn.1009-3419.2018.04.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
近年来,单孔胸腔镜技术迅速发展,已成为全球外科发展方向。单孔胸腔镜外科医师的针对性,规范化、系统化培训已成为重要的课题,技术培训是保证手术安全性的必不可少的重要环节。单孔电视胸腔镜技术培训应包括:由临床大中心经验丰富的专家直接面对面的教授手术技巧,或聘请专家导师前往学员所在单位进行针对性现场指导,这是一个代表性的、不可缺少的重要环节。网络视频通常也可以作为培训的方式。目前的技术提供了很多模拟训练,诸如:体外模拟器,人工合成胸腔、肺模型,动物实验,3D和VR技术能够为学习者提供各种层面的培训需求。对于大样本量的培训中心,短期的集中培训和中长期的系统性培训目前越来越受关注。根据学员的分级评估,采用多元化的培训模式,因材施教的针对性训练,有助于提高培训效果。我科在单孔胸腔镜外科医师培训方面做了一些工作,积累了一些培训经验,我们认为这样的培训是可行且完全有必要的。
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Affiliation(s)
- Yuming Zhu
- Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Gening Jiang
- Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Ma D, Song X, Li S, Liu H, Cui Y, Huang C, Zhou X, Qin Y, Li L, Chen Y. Video-Assisted Thoracoscopic Surgery Lobectomy Performed Satisfaction and Complications of Patients During Hands-On Training Courses. J Laparoendosc Adv Surg Tech A 2018; 28:804-810. [PMID: 29658824 DOI: 10.1089/lap.2017.0661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM It was aimed to concern about the satisfaction and procedural complications of patients during the thoracoscopy exist of hands-on training in this present study. PATIENTS AND METHODS The patients with non-small-cell carcinoma underwent video-assisted thoracoscopic surgery (VATS) lobectomy during hands-on training courses at thoracoscopic center in our hospital and collected from January 2009 and December 2014. The rates of satisfaction and complications of patients were compared from hands-on training group and control group. Potential risk factors associated with post-VATS complications of patients and thoracoscopist-related variables were analyzed. There were 54 patients join in six meetings with hands-on thoracoscopy training in our center. RESULTS There was no significant difference between patients for hands-on training group (n = 54) and control group (n = 54), including sex, age, BMI, smoking, PpoFEV1 and comorbidities. The satisfaction rate and the incidence of complication were similar between the two groups. CONCLUSION Univariate analyses showed that elder age, heart disease, chronic obstructive pulmonary disease, long operative time, and first-time mentorship were significantly associated with post-VATS complications of patients in hands-on training group. We should pay more attention to the characteristics of patent and the experience of mentor before VATS hands-on training courses.
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Affiliation(s)
- Dongjie Ma
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Xiaonan Song
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Yushang Cui
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Xiaoyun Zhou
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Yingzhi Qin
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Li Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
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9
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Sandri A, Filosso PL, Lausi PO, Ruffini E, Oliaro A. VATS lobectomy program: the trainee perspective. J Thorac Dis 2016; 8:S427-30. [PMID: 27195140 DOI: 10.21037/jtd.2016.03.82] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Due to its intrinsic characteristics, video assisted thoracic surgery (VATS) lobectomy is currently the recommended surgical approach for early stage lung cancer treatment. The importance of increasing the number of surgeons capable of performing VATS lobectomies is implicit and of utmost importance. In fact, the need of performing independently and routinely VATS lobectomies for early stage lung cancer will soon be a prerequisite to the new generation of thoracic surgeons. The feeling that VATS lobectomy teaching should be part of their training is strongly felt among trainees but, at the moment, a formal, uniform and certified process of learning VATS lobectomy is not available in all training centres. Perhaps, through the supervision, support and aid from national and European Thoracic Surgery Societies, programs of integration of recognized, standardized and certified teaching of VATS lobectomy could be planned and undertaken by the training centres, both at national as well as European level.
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Affiliation(s)
- Alberto Sandri
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | | | | | - Enrico Ruffini
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | - Alberto Oliaro
- Department of Thoracic Surgery, University of Torino, Torino, Italy
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Larsen P, Koelner-Augustson L, Elsoe R, Petruskevicius J, Rasmussen S. The long-term outcome after treatment for patients with tibial fracture treated with intramedullary nailing is not influenced by time of day of surgery and surgeon experience. Eur J Trauma Emerg Surg 2015; 43:221-226. [PMID: 26683568 DOI: 10.1007/s00068-015-0622-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/07/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of the present study was to evaluate the relationship between clinical outcome and time of day of surgery and experience level of the surgeon. Secondly, we examined the relationship between the length of hospital stay and the time of day of surgery. METHODS This retrospective cross-sectional cohort design study included patients treated with intramedullary nailing at Aalborg University Hospital from 1998 to 2008 after tibial shaft fractures (N = 294). At follow-up, the participants completed the Knee Injury and Osteoarthritis Outcome Score (KOOS). Age, sex, complications, length of hospital stay, start time of surgery, and education level of surgeons were recorded. RESULTS The long-term analysis of the KOOS assessment shows no significant association between time of day of surgery and the level of surgeon experience. There was no difference in complication rates between time of day of surgery and the level of surgeon experience. The secondary outcome analysis showed an estimated increased risk of 25 % (p = 0.001), for a longer length of hospital stay when operated by a trainee at night-hours compared to day-hours, and an estimated increased risk of 17 % (p = 0.002) for longer length of stay, when operated at day-hours by a trauma surgeon compared to a trainee. CONCLUSION Complication rates and KOOS outcome after surgery with intramedullary nailing were not influenced by time of day of surgery and experience level of the surgeon. The lengths of hospital stay increase significantly when surgery is performed at night by trainee surgeons, but not when performed by trauma surgeons.
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Affiliation(s)
- P Larsen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg University, 18-20 Hobrovej, 9000, Aalborg, Denmark.
| | - L Koelner-Augustson
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - R Elsoe
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - J Petruskevicius
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - S Rasmussen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
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Okyere S, Attia R, Toufektzian L, Routledge T. Is the learning curve for video-assisted thoracoscopic lobectomy affected by prior experience in open lobectomy?: Table 1. Interact Cardiovasc Thorac Surg 2015; 21:108-12. [DOI: 10.1093/icvts/ivv090] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/19/2015] [Indexed: 11/13/2022] Open
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Yu WS, Lee CY, Lee S, Kim DJ, Chung KY. Trainees Can Safely Learn Video-Assisted Thoracic Surgery Lobectomy despite Limited Experience in Open Lobectomy. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:105-11. [PMID: 25883893 PMCID: PMC4398157 DOI: 10.5090/kjtcs.2015.48.2.105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/06/2014] [Accepted: 11/07/2014] [Indexed: 11/24/2022]
Abstract
Background The aim of this study was to establish whether pulmonary lobectomy using video-assisted thoracic surgery (VATS) can be safely performed by trainees with limited experience with open lobectomy. Methods Data were retrospectively collected from 251 patients who underwent VATS lobectomy at a single institution between October 2007 and April 2011. The surgical outcomes of the procedures that were performed by three trainee surgeons were compared to the outcomes of procedures performed by a surgeon who had performed more than 150 VATS lobectomies. The cumulative failure graph of each trainee was used for quality assessment and learning curve analysis. Results The surgery time, estimated blood loss, final pathologic stage, thoracotomy conversion rate, chest tube duration, duration of hospital stay, complication rate, and mortality rate were comparable between the expert surgeon and each trainee. Cumulative failure graphs showed that the performance of each trainee was acceptable and that all trainees reached proficiency in performing VATS lobectomy after 40 cases. Conclusion This study shows that trainees with limited experience with open lobectomy can safely learn to perform VATS lobectomy for the treatment of lung cancer under expert supervision without compromising outcomes.
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Affiliation(s)
- Woo Sik Yu
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine
| | - Seokkee Lee
- Department of Thoracic Surgery, Armed Forces Capital Hospital
| | - Do Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine
| | - Kyung Young Chung
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine
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Savran MM, Hansen HJ, Petersen RH, Walker W, Schmid T, Bojsen SR, Konge L. Development and validation of a theoretical test of proficiency for video-assisted thoracoscopic surgery (VATS) lobectomy. Surg Endosc 2014; 29:2598-604. [DOI: 10.1007/s00464-014-3975-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 10/24/2014] [Indexed: 11/24/2022]
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Roubelakis A, Modi A, Holman M, Casali G, Khan AZ. Uniportal video-assisted thoracic surgery: the lesser invasive thoracic surgery. Asian Cardiovasc Thorac Ann 2014; 22:72-6. [PMID: 24585647 DOI: 10.1177/0218492313479356] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We evaluated whether single-port video-assisted thoracic surgery is feasible without compromising outcomes, and whether the technique could be reproduced by a trainee. METHODS In a 6-month period, 37 operations were performed by single-port video-assisted thoracic surgery. Of the 37 patients, 27 (73%) were male and the mean age was 45.1 ± 21 years. Twenty-three (62%) were operated on by consultants and 14 (38%) by trainees. The procedures included 19 (51.3%) operations for treatment of pneumothoraces, 8 (21.6%) metastasectomies, 7 (18.9%) lung biopsies, 2 (5.4%) empyema débridements, and 1 (2.7%) pleuropericardial window. RESULTS Mean operative time was 51.8 ± 14.7 min. Patient-controlled analgesia infusion was used for 1.3 ± 1 days. Three (8.1%) patients needed an operative reintervention, but there was no intensive treatment unit admission or hospital mortality. Mean postoperative hospital stay was 3.3 ± 2.7 days. On follow-up, all patients had a tissue diagnosis and all lung nodules were R0 resections. Patients operated on by consultants and trainees had similar preoperative profiles and postoperative outcomes, except that those operated on by trainees used patient-controlled analgesia significantly longer (1.8 ± 1.48 vs. 1 ± 0.48 days; p = 0.03). CONCLUSION Single-port video-assisted thoracic surgery can be performed and reproduced well without compromising outcomes. It is considered aesthetically better and may reduce analgesic requirements, but it might not reduce hospital stay.
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Kim AW, Fonseca AL, Boffa DJ, Detterbeck FC. Experience with Thoracoscopic Pneumonectomies at a Single Institution. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Anthony W. Kim
- Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT USA
| | | | - Daniel J. Boffa
- Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT USA
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Experience with Thoracoscopic Pneumonectomies at a Single Institution. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 9:82-6; discussion 86. [DOI: 10.1097/imi.0000000000000058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective The aim of this study was to review a single-institution experience with video-assisted thoracoscopic pneumonectomy (VATP). Methods From July 2008 through December 2012, the medical records of all patients undergoing pneumonectomy (total and completion) for lung cancer were reviewed. Clinical parameters were recorded and analyzed. Results During this period, 16% (7/45) of pneumonectomies for malignancy were performed thoracoscopically. Patient selection was performed in the context of a multidisciplinary tumor board. Of the seven VATPs, five were standard (Video 1, available at http://links.lww.com/INNOV/A40 ) and two were completion pneumonectomies (Video 2, available at http://links.lww.com/INNOV/A41 ). Indications were primary lung cancer in six (three adenocarcinoma, one squamous carcinoma, one large cell neuroendocrine carcinoma, and one mixed adenocarcinoma cell and small cell lung carcinoma) and metastatic esophageal cancer in one patient. Preoperative selection was based on unfavorable location of the primary tumor, which excluded the possibility of a lesser resection such as sleeve resection while permitting an R0 resection by pneumonectomy. Pathologic staging was consistent with clinical staging except for one patient who was upstaged. There were four complications: atrial fibrillation, pneumonia, and two bronchopleural fistulas. The median length of stay was 4 days (excluding one outlier). Distant disease recurrence occurred in one patient. Kaplan-Meier survival at 24 months was 75%. Conclusions Introduction of VATP into the armamentarium of the experienced thoracoscopic surgeon is feasible with acceptable outcomes and a complication profile that is not dissimilar to the open pneumonectomy experience. Greater experience with this approach should provide additional data to more objectively evaluate the merits of this approach.
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Impact of surgical training and surgeon’s experience on early outcome in kidney transplantation. Langenbecks Arch Surg 2013; 398:581-5. [DOI: 10.1007/s00423-013-1073-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 02/25/2013] [Indexed: 10/27/2022]
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Thoracoscopic lobectomy: is a training program feasible with low postoperative morbidity? Gen Thorac Cardiovasc Surg 2013; 61:409-13. [DOI: 10.1007/s11748-013-0225-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
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Ahmed K, Ashrafian H, Harling L, Patel VM, Rao C, Darzi A, Hanna GB, Punjabi P, Athanasiou T. Safety of training and assessment in operating theatres--a systematic review and meta-analysis. Perfusion 2012; 28:76-87. [PMID: 23015638 DOI: 10.1177/0267659112460882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Procedural outcomes can be used to assess the performance of specialists and trainees. This article establishes a systematic evidence base for the safety of training in the operating theatre. It also explores the possibility of using early, intermediate and late procedural outcomes of cardiac surgical operations to evaluate the performance of the clinicians and the healthcare system. METHODS Medline, EMBASE and PsycINFO databases were searched. Comparative studies evaluating quality indicators of cardiac surgical procedures (coronary artery bypass grafting (CABG) and valve surgery) were included. guidelines from the preferred reporting items for systematic reviews and meta-analyses (PRISMA) were used. RESULTS Fourteen studies met the inclusion criteria. For CABG, meta-analysis of outcomes did not show any significant differences between the technical and non-technical skills of trainees versus specialists apart from bypass time (less for specialists) and intensive care unit (ICU) length of stay (less for trainees). Studies reporting outcomes on valve surgery also did not report any statistically significant differences amongst the outcomes. CONCLUSION This systematic review did not discern any significant differences between the procedural outcomes of trainees and specialists, which indicates that trainees are safe to operate under senior supervision. In addition, this article recommends that various procedural outcomes can be used to evaluate the performance of clinicians and healthcare systems. Prospective studies need to be performed, taking into account the specific contribution of trainees and specialists during the procedure. This will give a clearer indication of safety and performance of trainees and specialists in the operating theatre.
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Affiliation(s)
- K Ahmed
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, London, UK
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van der Leeuw RM, Lombarts KMJMH, Arah OA, Heineman MJ. A systematic review of the effects of residency training on patient outcomes. BMC Med 2012; 10:65. [PMID: 22742521 PMCID: PMC3391170 DOI: 10.1186/1741-7015-10-65] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 06/28/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Residents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes. METHODS The literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes. RESULTS Ninety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design. Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained. CONCLUSIONS The majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.
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Affiliation(s)
- Renée M van der Leeuw
- Professional Performance Research Group, Department of Quality Management and Process Innovation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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Richards JMJ, Dunning J, Walker WS. Training in video-assisted thoracoscopic lobectomy. Ann Cardiothorac Surg 2012; 1:33-6. [PMID: 23977462 DOI: 10.3978/j.issn.2225-319x.2012.04.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/23/2012] [Indexed: 11/14/2022]
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Ferraris VA, Saha SP, Davenport DL, Zwischenberger JB. Thoracic Surgery in the Real World: Does Surgical Specialty Affect Outcomes in Patients Having General Thoracic Operations? Ann Thorac Surg 2012; 93:1041-7; discussion 1047-8. [DOI: 10.1016/j.athoracsur.2011.12.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 12/08/2011] [Accepted: 12/12/2011] [Indexed: 10/28/2022]
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Cash H, Slowinski T, Buechler A, Grimm A, Friedersdorff F, Schmidt D, Miller K, Giessing M, Fuller TF. Impact of surgeon experience on complication rates and functional outcomes of 484 deceased donor renal transplants: a single-centre retrospective study. BJU Int 2012; 110:E368-73. [PMID: 22404898 DOI: 10.1111/j.1464-410x.2012.011024.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine how postoperative and functional outcomes after deceased donor renal transplantation (DDRT) are related to surgeon experience. PATIENTS AND METHODS The outcomes of 484 adult DDRT performed by 13 urological surgeons were retrospectively reviewed. After completion of a staged renal transplant training programme under supervision of an attending urological transplant surgeon, the 13 surgeons were either assigned to the inexperienced group (n = 8) or the experienced group (n = 5). Surgeons in the experienced group had performed more than 30 unsupervised DDRT in a standard fashion with routine ureteric stenting. Between 1988 and 2005, inexperienced surgeons performed 152 DDRT, whereas experienced surgeons performed 332 DDRT. RESULTS Patient and graft survival at 2 hyears were 98% and 94.7%, respectively. Early graft loss in five recipients was unrelated to surgeon experience. Delayed graft function occurred in 29% of cases and median 1-year serum-creatinine was 1.48 mg/dL, with no difference between surgeon groups. Postoperative bleeding and lymphocele formation were the most frequent surgical complications, with an equal distribution between groups. Ureteric complications had a significantly higher incidence among inexperienced surgeons (6.6% versus 2.7%; P = 0.04). CONCLUSION We conclude that DDRT as performed by inexperienced urological renal transplant surgeons has both acceptable short- and long-term outcomes.
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Affiliation(s)
- Hannes Cash
- Department of Urology, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany
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Abstract
BACKGROUND To meet Australia's future demands, surgical training in the private sector will be required. The aim of this study was to estimate the time and lost opportunity cost of training in the private sector. METHODS A literature search identified studies that compared the operation time required by a supervised trainee with a consultant. This time was costed using a business model. RESULTS In 22 studies (34 operations), the median operation duration of a supervised trainee was 34% longer than the consultant. To complete a private training list in the same time as a consultant list, one major case would have to be dropped. A consultant's average lost opportunity cost was $1186 per list ($106,698 per year). Training in rooms and administration requirements increased this to $155,618 per year. To train 400 trainees in the private sector to college standards would require 54,000 training lists per year. The consultants' national lost opportunity cost would be $137 million per year. The average lost hospital case payment was $5894 per list, or $330 million per year nationally. The total lost opportunity cost of surgical training in the private sector would be about $467 million per year. When trainee salaries, other specialties and indirect expenses are included, the total cost will be substantially greater. CONCLUSION It is unlikely that surgeons or hospitals will be prepared to absorb these costs. There needs to be a public debate about the funding implications of surgical training in the private sector.
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Affiliation(s)
- R James Aitken
- Hollywood Medical Centre, Nedlands, Western Australia, Australia.
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Video-assisted thoracic surgery lobectomy for lung cancer: the point at issue. Gen Thorac Cardiovasc Surg 2011; 59:164-8. [PMID: 21448791 DOI: 10.1007/s11748-010-0708-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/01/2010] [Indexed: 10/18/2022]
Abstract
Among the four subjects addressed in this article, the definition of video-assisted thoracic surgery (VATS) lobectomy is fundamentally the point at issue, which leads to various obstacles for upcoming clinical trials. It is strongly expected that VATS lobectomy will be identified as a standard operation for primary lung cancer with confirmed clinical evidence. Standard surgical procedure with a certain oncological validity for lung cancer should be minimally invasive, safe, and technically simple for general thoracic surgeons. In conclusion, most patients with resectable lung cancer will be able to benefit from a validated painless VATS lobectomy in the near future.
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Video-Assisted Thoracic Lung Surgery: Is There a Barrier to Widespread Adoption? Ann Thorac Surg 2010; 89:S2112-3. [DOI: 10.1016/j.athoracsur.2010.02.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 02/11/2010] [Accepted: 02/17/2010] [Indexed: 11/19/2022]
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Abstract
Minimally invasive thoracic surgery (MITS) has become part of the modern thoracic surgeon's armamentarium. Its applications include diagnostic and therapeutic procedures, and over the past one and a half decades, the scope of MITS has undergone rapid evolution. The role of MITS is well established in the management of pleural and mediastinal conditions, and it is beginning to move beyond diagnostic procedures for lung parenchyma conditions, to gain acceptance as a viable option for primary lung cancer treatment. However MITS poses technical challenges that are quite different from the conventional open surgical procedures. After a brief review of the history of MITS, an overview of the scope of MITS is given. Important examples of diagnostic and therapeutic indications are then discussed, with special emphasis on the potential complications specific to MITS, and their prevention and management.
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Affiliation(s)
- Michael K Y Hsin
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
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Seder CW, Hanna K, Lucia V, Boura J, Kim SW, Welsh RJ, Chmielewski GW. The Safe Transition from Open to Thoracoscopic Lobectomy: A 5-Year Experience. Ann Thorac Surg 2009; 88:216-25; discussion 225-6. [PMID: 19559229 DOI: 10.1016/j.athoracsur.2009.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Revised: 03/31/2009] [Accepted: 04/02/2009] [Indexed: 11/24/2022]
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Link BA, Nelson R, Josephson DY, Lau C, Wilson TG. Training of urologic oncology fellows does not adversely impact outcomes of robot-assisted laparoscopic prostatectomy. J Endourol 2009; 23:301-5. [PMID: 19196060 DOI: 10.1089/end.2008.0378] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Robot-assisted laparoscopic prostatectomy (RALP) is an increasingly popular treatment choice among men with clinically localized prostate cancer and has resulted in the need to adequately train urologists to perform the procedure. We reviewed the City of Hope experience to determine if the extent of fellow involvement in the procedure has an adverse effect on surgical outcomes. PATIENTS AND METHODS We reviewed the charts of 1833 patients who underwent RALP at the City of Hope from January 2004 to September 2007. During the academic year, each fellow has participated in 300 or more RALP with a systematic stepwise approach to learning the operation. The procedure is divided into six segments arranged by the sequence of learning. We examined intraoperative and perioperative outcomes stratified by quartiles of the academic year corresponding to the fellows' progress through the different segments of the operation. RESULTS No differences were found across quartiles of the academic year for intraoperative or perioperative complications, length of hospital stay, continence rates at 1 year, time to continence, and prostate-specific antigen-free recurrence rates. In the 1st and 3rd quarters of the academic year, from July to September and January to March, there were slightly longer operative times with a mean of 2.9 hours compared with the 2nd and 4th quarter mean of 2.8 hours (P = 0.01). The 3rd quarter also demonstrated slightly higher estimated blood loss of 280 mL compared with the overall mean of 262 mL (P = 0.02). During the 3rd quarter of the year, the fellows are reliably performing bladder neck division, urethral anastomosis, and beginning to learn the dissection of the neurovascular bundles. CONCLUSIONS We found that in a high-volume center for RALP, urologic oncology fellows can be trained to perform the procedure with no significant adverse impact on patient clinical outcomes.
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Affiliation(s)
- Brian A Link
- Department of Urology, City of Hope, Duarte, California 91010, USA.
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