Objective To explore the clinical efficacy and learning curve of robot-assisted thymectomy via subxiphoid approach. MethodsThe clinical data of patients with robot-assisted thymectomy surgery via subxiphoid approach performed by the same surgical team in the Department of Thoracic Surgery of Shanghai Pulmonary Hospital from February 2021 to August 2022 were retrospectively analyzed. The cumulative sum (CUSUM) analysis and best fit curve were used to analyze the learning curve of this surgery. The general information and perioperative indicators of patients at different learning stages were compared to explore the impact of different learning stages on clinical efficacy of patients. ResultsA total of 67 patients were enrolled, including 31 males and 36 females, aged 57.10 (54.60, 59.60) years. The operation time was 117.00 (87.00, 150.00) min. The best fitting equation of CUSUM learning curve was y=0.021 2x3–3.192 5x2 +120.17x–84.444 (x was the number of surgical cases), which had a high R2 value of 0.977 8, and the fitting curve reached the top at the 25th case. Based on this, the learning curve was divided into a learning period and a proficiency period. The operation time and intraoperative blood loss in the proficiency stage were significantly shorter or less than those in the learning stage (P＜0.001), and there was no statistical difference in thoracic drainage time and volume between the two stages (P＞0.05). ConclusionThe learning process of robot-assisted thymectomy via subxiphoid approach is safe, and this technique can be skillfully mastered after 25 cases.
ObjectiveTo monitor surgical quality and analyze learning curve of minimally invasive mitral valve replacement (MVR)through right minithoracotomy with cumulative sum analysis (CUSUM analysis). MethodsClinical data of 60 consecutive patients who underwent minimally invasive MVR through right minithoracotomy in the Fourth Affiliated Hospital of Guangxi Medical University from June 2011 to April 2013 were retrospectively analyzed. There were 32 male and 28 female patients with their age of 28-53 (34.67±7.11)years and their heart function ranging from NYHA class Ⅱ to Ⅳ. There were 31 patients with mitral stenosis (MS), 19 patients with mitral regurgitation (MR), and 10 patients with MS and MR. According to the surgical sequence, all the patients were divided into 3 groups (group A, B and C)with 20 patients in each group. Surgical outcomes were compared among the 3 groups, and surgical quality was analyzed with descriptive statistics and CUSUM curves. ResultsAortic cross-clamp time, cardiopulmonary bypass time and operation time of group C were significantly shorter than those of group A and group B (aortic cross-clamp time of group C vs. group A:50.35±2.30 minutes vs. 66.15±8.38 minutes; operation time of group C vs. group B:167.50±4.63 minutes vs. 178.60±4.49 minutes, P < 0.05). In-hospital mortality was 3.3% (2/60). CUSUM analysis showed a significant learning curve effect, although surgical quality remained in control during the study period. Surgical failure rate was lower than 80% after about 45 operations, indicating that failure rate was 10% lower than expectation. ConclusionMinimally invasive MVR is safe and reliable, and CUSUM analysis is a simple statistical method to monitor surgical quality.
ObjectiveTo investigate how to shorten the learning curve of the laparoscopic pancreaticoduodenectomy (LPD). MethodsClinical data of 5 patients who underwent the LPD in our hospital from May 2015 to November 2015 were retrospectively analyzed. ResultsThe mean age of 58.8 years old. There were four patients who were diagnosed with periampullary tumor, one patient was distal bile duct carcinoma. The median operative time was 588 min, the average blood loss was 290 mL, the time of feeding was 5 days, the mean hospital stay was 25 days. One case died of cardiovascular event on postoperative day 1. One patient had postoperative bleeding after LPD, who recovered smoothly after reoperation for hemostasis laparoscopiclly. Conciusions LPD needs basic learning curve. The key of this procedure are appropriate treatment of pancreatic head and digestive tract reconstruction. Rich operative experience of surgeon in pancreaticoduodenectomy, optimization of the operation process, skilled in laparoscopic procedures, appropriate cases, appropriate perioperative management, and steady surgical team are also important factor for the success of LPD and shorten learning curve.
Objective To summarize the experiences in learning laparoscopic cholecystectomy （LC） and discuss young surgeons how to learn LC scientifically. Method The clinical data of 198 patients received LC by myself since I got the qualification of LC were analyzed retrospectively. Results LC was performed successfully in 187 patients with an average operation time of 68 min. Eleven patients were converted to laparotomy. In these 11 patients， 10 patients because of unclear anatomy in Calot triangle and 1 patient because of uncontrollable bleeding due to pathologic anatomy in Calot triangle caused by gallstone. All 198 patients did not suffer from complications such as severe hemorrhage or injury of biliary duct. Liquid therapy and antibiotics therapy were applied in patients with cholecystitis after LC. Food intake and ambulation were recovered at 12-24h after operation. All the patients were discharged from hospital with anaverage of 2.8d after LC. There was no complications related bile duct injury in all of the patients. Conclusion Managed by hierarchical operations management system， mastering regional physiological and variant anatomy， making use of other open cholecystectomy and laparoscopic simulative learning system well， complying with the learning curve， controlling the indications， contraindications and timing of conversion to laparotomy， young surgeons are able to master LC scientifically， safely， and solidly.
ObjectiveTo analyze the learning curve of Da Vinci robotic segmentectomy. MethodsCumulative sum analysis (CUSUM) was used to analyze the learning curve of Da Vinci robotic segmentectomy performed by the General Hospital of Northern Theater Command from February 2018 to December 2020. The learning curve was obtained by fitting, and R2 was used to judge the goodness of fitting. The clinical data of patients in different stages of learning curve were compared and analyzed. Results The first 50 patients who received Da Vinci robotic segmentectomy were included, including 24 males and 26 females, with an average age of 61.9±10.6 years. The operation time decreased gradually with the accumulation of operation patients. The goodness of fitting coefficient reached the maximum value when R2=0.907 (P<0.001), CUSUM (n) =0.009×n3−0.953×n2+24.968×n−7.033 (n was the number of patients). The fitting curve achieved vertex crossing when the number of patients reached 17. Based on this, 50 patients were divided into two stages: a learning and improving stage and a mastering stage. There were statistical differences in the operation time, intraoperative blood loss, postoperative drainage volume, number of lymph node dissection, postoperative catheter time, postoperative hospital stay, and postoperative complications between the two stages (P<0.05). ConclusionIt shows that the technical competency for assuring feasible perioperative outcomes can be achieved when the cumulative number of surgical patients reaches 17.
ObjectiveTo investigate the influence of the degree of acetabular deformity and the learning-curve on the acetabular cup positions in total hip arthroplasty (THA) for adults with developmental dysplasia of hip (DDH). MethodsBetween January 2008 and December 2015, 130 patients (144 hips) with DDH underwent primary THA, and the clinical data were analyzed retrospectively. Fifty-three patients (59 hips) were admitted before 2012, and 77 patients (85 hips) were treated after 2012. There were 32 males and 98 females, aged from 31 to 83 years (mean, 61). Unilateral replacement was performed in 116 cases and bilateral replacement in 14 cases. Of 144 hips, 48 hips were rated as Crowe type I, 57 hips as type II, and 39 hips as type of III/IV. The standard pelvic radiograph was taken within 1 week after operation. The mediCAD software was adopted to measure the angle of anteversion and abduction, bony coverage, and the distance between true rotating center and optimal rotating center to the connection of teardrops and the horizontal distance between two centers to evaluate the qualified rate of acetabular cup positions. ResultsCompared with the patients with the same type in 2013-2015 group, the anteversion angle and qualified rate of acetabular cup position significantly decreased in patients with Crowe I (P < 0.05); the horizontal distance significantly increased and qualified rate of acetabular cup position significantly decreased in patients with Crowe II (P < 0.05); and the anteversion angle significantly decreased and the horizontal distance significantly increased in patients with Crowe III/IV (P < 0.05) in 2008-2012 group. But no significant difference was shown in the other indexes (P > 0.05). In all Crowe types, the vertical distance between the true rotating center and the optimal rotating center increased with the degree of acetabular deformity in both 2008-2012 group and 2013-2015 group, showing significant difference (P < 0.05), but no significant difference was found in the other indexes (P > 0.05). ConclusionFor adults with acetabular dysplasia, there are high potential risks for unsatisfactory acetabular cup positions during primary THA. So it is necessary to evaluate acetabular deformities and to sum up operative experience so as to improve the accuracy of cups installation.
Objective To monitor surgical quality and analyze learning curve of minimally invasive totally thoracoscopic cardiac surgery. Methods We retrospectively analyzed the clinical data of 150 consecutive patients who underwent minimally invasive totally thoracoscopic cardiac surgery in the Guangdong General Hospital between January 2013 and December 2015. There were 60 males and 90 females at age of 43.1 years. There were 60 patients with atrial or ventricular septal defect repair, 12 patients with cardiac tumor resection, 53 patients with mitral valve replacement and 25 patients with mitral valve repair. According to the surgical sequence, all the patients were divided into 3 groups including a group A, group B, and group C with 50 patients in each group (every 10 patients as a sequence, every 5 sequence as a group). Surgical outcomes were compared among the 3 groups, and surgical quality was analyzed with descriptive statistics. Results Surgical failure rate was 6.7% (10/150). There was no in-hospital mortality. Aortic cross-clamp time, cardiopulmonary bypass time and duration of mechanical ventilation, duration of ICU stay, duration of hospital stays of the group C were significantly shorter than those of the group A and group B. Analysis showed a significant learning curve effect in totally thoracoscopic cardiac surgery. When surgical cases reached about 100 cases, cardiopulmonary bypass and aortic cross-clamp time was shorter than the average value stably. Conclusion Totally thoracoscopic cardiac surgery is safe and reliable. For the beginners, it needs about 100 patients of surgery to master the totally thoracoscopic cardiac surgery.
Objective To investigate the learning curve of laparoscopic assisted rectal cancer radical resection of a surgeon and share the experience of laparoscopic surgery. Methods The date of 119 consecutive patients who were suffered operation by same team during January 2010 to December 2015 were retrospectively analyzed. The learning curve and its stages were obtained by using weighted moving average method, cumulative sum analysis(CUSUM), risk-adjusted CUSUM (RA-CUSUM)and Matlab software. The effects of each stage, such as operative time, intraoperative bold loss, harvested lymph node numbers, distal margin to the edge of tumor, complications after operation, hospital stay days, and the first time take soft food were compared, and the experience of laparoscopic assisted surgery for rectal cancer was summarized. Results Our learning curve was divided into three periods, the cutting point was around 36th and 80th cases, respectively. There was no significant difference between the 3 stages in general data, however when comparing the operative time, loss of blood, harvested lymph node numbers, the distal margin to the edge of tumor, hospital stay and total complications, the last period were best and the first stage were worst. Conclusions The learning curve can be divided into three stages, the exploration, mastery and proficient period. Our term, fixed and with rich experience in laparotomy, completed our first exploration period at about 36th patients and the second stage is around 80th cases. And the short term effect of each period’s had gradually improved with master of laparoscopic technique.
ObjectiveTo explore the learning curve of single pore video-assisted thoracoscopic surgery (VATS) for the treatment of pulmonary bullae. MethodsFrom July 2010 to October 2011, sixty consecutive patients with pulmo-nary bulla undergoing single pore VATS by the same group of surgeons in the Department of Thoracic and Cardiovascular Surgery, Songgang People's Hospital. According to the sequence of the operations, all the patients were divided into group A, B, and C with 20 patients in each group. Operation time, intraoperative blood loss, postoperative hospital stay and thoracic drainage duration were compared between the 3 groups to evaluate surgical outcomes in different stages. Operation time and postoperative hospital stay were the main indexes of the learning curve. ResultsThere was no statistical difference in age, gender or incidence of pneumothorax between the 3 groups (P > 0.05). Operation time of group A (42.7±9.4 minutes) was significantly longer than those of group B (21.3±6.7 minutes) and group C (20.8±7.5 minutes) (P < 0.01). Postoperative hospital stay of group A (10.6±2.2 days) was significantly longer than those of group B (7.6±1.2 days) and group C (7.4±1.2 days) (P < 0.05). There was no statistical difference in other indexes among the 3 groups (P > 0.05). ConclusionThe learning curve of single pore VATS for the treatment of pulmonary bullae is approximately 20 cases.