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The learning curve for transurethral enucleation with bipolar energy for benign prostate hyperplasia:a single-surgeon experience of 494 patients

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Asian Journal of Andrology 2024年第3期26卷 288-294页

作者： Byeongdo Song Sang Hun Song Seong Jin Jeong Department of Urology Seoul National University Bundang HospitalSeongnam 13620Korea Department of Urology Seoul National University College of MedicineSeoul 03080Korea

This study was performed to investigate the learning curve of transurethral enucleation with bipolar energy(TUEB)for benignprostatic *** study involved 494 consecutive patients who underwent TUEB for benign prostatic hyperplasia fromAugust 2018 to March 2022 by one surgeon(SJJ,Seoul National University Bundang Hospital,Seongnam,Korea).The patientswere followed up at 1 week,1 month,3 months,and 6 months *** evaluate the learning curve of TUEB,perioperativeparameters including the enucleation ratio(enucleated tissue weight/transitional zone volume),TUEB efficiency(enucleatedtissue weight/operation time),and enucleation efficiency(enucleated tissue weight/enucleation time)were *** and postoperative complications were also assessed,including the International Prostate Symptom Score(IPSS),IPSSquality-of-life(QoL)score,and uroflowmetry *** patients’median age was 72(interquartile range[IQR]:66–78)years,and the estimated prostate volume and transitional zone volume were 63.0(IQR:46.0–90.6)ml and 37.1(IQR:24.0–60.0)ml,*** enucleation ratio,TUEB efficiency,and enucleation efficiency were 0.60(IQR:0.46–0.54)g ml−1,0.33(IQR:0.22–0.46)g min−1,and 0.50(IQR:0.35–0.72)g min−1,respectively,plateauing after 70 *** functional outcomes,including total IPSS,IPSS QoL score,and uroflowmetry outcomes,significantly improved at 6 months after TUEB(all Plearning ***-five(13.2%)patients developed complications after TUEB,21.5%of whom experienced major complications(Clavien–Dindo grade≥3).The rate of major complications declined as the number ofTUEB cases increased(P=0.013).Our results suggest that the efficiency of TUEB stabilized within 70 procedures.

关键词： benign prostate hyperplasia learning curve perioperative efficiency prostate transurethral enucleation with bipolar energy

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Proficiency score as a predictor of early trifecta achievement during the learning curve of robot-assisted radical prostatectomy for high-risk prostate cancer: Results of a multicentric series

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CURRENT UROLOGY 2024年第2期18卷 110-114页

作者： Anceschi, Umberto Flammia, Rocco Simone Tufano, Antonio Morelli, Michele Galfano, Antonio Luciani, Lorenzo Giuseppe Misuraca, Leonardo Dell'Oglio, Paolo Tuderti, Gabriele Brassetti, Aldo Ferriero, Maria Consiglia Bove, Alfredo Maria Mastroianni, Riccardo Prata, Francesco Sperduti, Isabella Petralia, Giovanni Secco, Silvia Di Trapani, Ettore Mattevi, Daniele Cai, Tommaso Bocciardi, Aldo Massimo Simone, Giuseppe IRCCS Regina Elena Natl Canc Inst Dept Urol Rome Italy Sapienza Univ Rome Dept Maternal Child & Urol Sci Urol Clin Rome Italy Sapienza Univ Rome Policlin Umberto I Dept Maternal Childand Urol Sci Urol Clin Viale Policlin 155 IT-00161 Rome Italy Osped Niguarda Ca Granda Dept Urol Milan Italy APSS Santa Chiara Reg Hosp Dept Urol Trento Italy IRCCS Regina Elena Natl Canc Inst Dept Biostat Unit Rome Italy

Background: Recently, an innovative tool called "proficiency score" was introduced to assess the learning curve for robot-assisted radical prostatectomy (RARP). However, the initial study only focused on patients with low-risk prostate cancer for whom pelvic lymph node dissection (PLND) was not required. To address this issue, we aimed to validate proficiency scores of a contemporary multicenter cohort of patients with high-risk prostate cancer treated with RARP plus extended PLND by trainee surgeons. Material and methods: Between 2010 and 2020, 4 Italian institutional prostate-cancer datasets were merged and queried for "RARP" and "high-risk prostate cancer." High-risk prostate cancer was defined according to the most recent European Association of Urology guidelines as follows: prostate-specific antigen >20 ng/mL, International Society of Urological Pathology >= 4, and/or clinical stage (cT) >= 2c on preoperative imaging. The selected cohort (n = 144) included clinical cases performed by trainee surgeons (n = 4) after completing their RARP learning curve (50 procedures for low-risk prostate cancer). The outcome of interest, the proficiency score, was defined as the coexistence of all the following criteria: a comparable operation time to the interquartile range of the mentor surgeon at each center, absence of any significant perioperative complications Clavien-Dindo Grade 3-5, no perioperative blood transfusions, and negative surgical margins. A logistic binary regression model was built to identify the predictors of 1-year trifecta achievement in the trainee cohort. For all statistical analyses, a 2-sided p < 0.05 was considered significant. Results: A proficiency score was achieved in 42.3% patients. At univariable level, proficiency score was associated with 1-year trifecta achievement (odds ratio, 8.77; 95% confidence interval, 2.42-31.7; p = 0.001). After multivariable adjustments for age, nerve-sparing, and surgical technique, the proficiency score independe

关键词： Trifecta learning curve Robot-assisted radical prostatectomy High-risk prostate cancer LYMPH-NODE DISSECTION FUNCTIONAL OUTCOMES SIOG GUIDELINES LOCAL TREATMENT MANAGEMENT DIAGNOSIS

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3D image system improves the learning curve and contributes to medical education of rhinoplasty

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Chinese Journal of Plastic and Reconstructive Surgery 2024年第2期6卷 72-75页

作者： Chen Cheng Caiyue Liu Jiafei Yang Yingfan Zhang Department of Plastic and Reconstructive Surgery Shanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai 200011China

Background: Rhinoplasty is a complex surgical procedure that requires critical analysis and precise design before surgery, making it a challenging operation for both the surgical team and medical educators. This study aimed to evaluate the impact of 3D design involvement on learning curves and to establish a more effective method for rhinoplasty ***: Surgeons who participated in an educational program were divided into two groups. The experimental group was involved in the 3D design before the operation, and the control group was asked to review the rhinoplasty atlas. A self-assessment questionnaire was used to evaluate the learning curve of the eight rhinoplasty procedures for each surgeon, and the overall satisfaction rate data were also ***: The self-assessment scores in both groups showed an increasing trend from the first to the eighth operation. The mean scores of the experimental group were significantly higher than those of the control group at the fifth operation(P=0.01). The satisfaction rate of the experimental group(91.7%) was higher than that of the control group(54.5%).Conclusion: The 3D imaging system can improve the learning curve and satisfaction rate of rhinoplasty education,proving that it is an easy and effective tool for medical education.

关键词： Rhinoplasty learning curve Medical education 3D design

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learning curve of totally thoracoscopic pulmonarysegmentectomy

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Frontiers of Medicine 2018年第5期12卷 586-592页

作者： Weibing Wu Jing Xu Wei Wen Yue Yu Xinfeng Xu Quan Zhu Liang Chen Department of Thoracic Surgery The First Affiliated Hospital of Nanjing Medical University Nanjing 210029 China

Totally thoracoscopic pulmonary segmentectomy (TTPS) is a feasible and safe technique that requires advanced thoracoscopic skills and knowledge of pulmonary anatomy. However, data describing the learning curve of TTPS have yet to be obtained. In this study, 128 patients who underwent TTPS between September 2010 and December 2013 were retrospectively analyzed to evaluate the learning curve and were divided chronologically into three phases, namely, ascending phase (A), plateau phase (B), and descending phase (C), through cumulative summation (CUSUM) for operative time (OT). Phases A, B, and C comprised 39, 33, and 56 cases, respectively. OT and blood loss decreased significantly from phases A to C (P learning curve of TTPS should be more than 72 cases.

关键词： thoracoscopic segmentectomy learning curve CUSUM

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learning curve of computer-assisted navigation system in spine surgery

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Chinese Medical Journal 2010年第21期123卷 2989-2994页

作者： BAI Yu-shu ZHANG Ye CHEN Zi-qiang WANG Chuan-feng ZHAO Ying-chuan SHI Zhi-cai LI Ming LIU Ka Po Gabriel Department of Orthopedic Surgery Changhai Hospital Second Military Medical University Shanghai 200433 China University Orthopaedics National University Hospital Singapore119074

Background Spine surgery using computer-assisted navigation （CAN） has been proven to result in low screw misplacement rates, low incidence of radiation exposure and excellent operative field viewing versus the conventional intraoperative image intensifier （CⅢ）. However, as we know, few previous studies have described the learning curve of CAN in spine *** We performed two consecutive case cohort studies on pedicel screw accuracy and operative time of two spine surgeons with different experience backgrounds, A and B, in one institution during the same period. Lumbar pedicel screw cortical perforation rate and operative time of the same kind of operation using CAN were analyzed and compared using CⅢ for the two surgeons at initial, 6 months and 12 months of CAN *** CAN spine surgery had an overall lower cortical perforation rate and less mean operative time compared with CⅢ for both surgeon A and B cohorts when total cases of four years were included. It missed being statistically significant,with 3.3% versus 4.7% （P=0.191） and 125.7 versus 132.3 minutes （P=0.428） for surgeon A and 3.6% versus 6.4%（P=0.058）, and 183.2 versus 213.2 minutes （P=0.070） for surgeon B. in an attempt to demonstrate the learning curve,the cases after 6 months of the CAN system in each surgeon＇s cohort were compared. The perforation rate decreased by 2.4% （P=0.039） and 4.3% （P=0.003） and the operative time was reduced by 31.8 minutes （P=0.002） and 14.4 minutes （P=0.026） for the CAN groups of surgeons A and B, respectively. When only the cases performed after 12 months using the CAN system were considered, the perforation rate decreased by 3.9% （P=0.006） and 5.6% （P 〈0.001） and the operative time was reduced by 20.9 minutes （P 〈0.001） and 40.3 minutes （P 〈0.001） for the CAN groups of surgeon A and B, *** In the long run, CAN spine surgery decreased the lumbar screw cortical perforation rate and operative time. The learning curve showed a sharp drop aft

关键词： computer-assisted navigation learning curve degenerative scoliosis spine surgery

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learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer

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World Journal of Gastroenterology 2005年第47期11卷 7508-7511页

作者： Min-Chan Kim Ghap-Joong Jung Hyung-Ho Kim Ghap-Joong Jung Department of SurgeryDong-A University College of MedicineBusanKorea Department of Surgery Seoul National University Bundang HospitalGyeonggi-doKorea

AIM: To evaluate the nature of the 'learning curve' for laparoscopy-assisted distal gastrectomy (LADG) with systemic lymphadenectomy for early gastric cancer. METHODS: The data of 90 consecutive patients with early gastric cancer who underwent LADG with systemic lymphadenectomy between April 2003 and November 2004 were reviewed. The 90 patients were divided into 9 sequential groups of 10 cases in each group and the average operative time of these 9 groups were determined. Other learning indicators, such as transfusion requirements, conversion rates to open surgery, postoperative complication, time to first flatus, and postoperative hospital stay, were evaluated. RESULTS: After the first 10 LADGs, the operative time reached its first plateau (230-240 min/operation) and then reached a second plateau (＜200 min/operation) for the final 30 cases. Although a significant improvement in the operative time was noted after the first 50 cases, there were no significant differences in transfusion requirements, conversion rates to open surgery, postoperative complications, time to first flatus, or postoperative hospital stay between the groups. CONCLUSION: Based on operative time analysis, this study show that experience of 50 cases of LADG with systemic lymphadenectomy for early gastric cancer is required to achieve optimum proficiency.

关键词： Laparoscopic gastrectomy, Systemic lymphadenectomy learning curve

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learning curve for a surgeon in robotic pancreaticoduodenectomy through a“G”-shaped approach:A cumulative sum analysis

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World Journal of Clinical Cases 2022年第14期10卷 4357-4367页

作者： Zhi-Gang Wei Chao-Jie Liang Yang Du Yong-Ping Zhang Yu Liu Department of Hepatobiliary and Pancreatic Surgery The First Hospital of Shanxi Medical UniversityTaiyuan 030001Shanxi ProvinceChina Department of Hepatobiliary and Pancreatic Surgery The First Hospital of Shanxi Medical UniversityShanxi Medical UniversityTaiyuan 030001Shanxi ProvinceChina Operating Room The First Hospital of Shanxi Medical UniversityTaiyuan 030001Shanxi ProvinceChina Department of Hepatobiliary and Pancreatic Surgery The First Hospital/First Clinical Medical College of Shanxi Medical UniversityTaiyuan 030001Shanxi ProvinceChina

BACKGROUND Robotic pancreaticoduodenectomy(RPD)can achieve similar surgical results to open and PD;however,RPD has a long learning curve and operation time(OT).To address this issue,we have summarized a surgical path to shorten the surgical learning curve and *** To investigate the effective learning curve of a“G”-shaped surgical approach in RPD for *** A total of 60 patients,who received“G”-shaped RPD(GRPD)by a single surgeon in the First Hospital of Shanxi Medical University from May 2017 to April 2020,were included in this *** OT,demographic data,intraoperative blood loss,complications,hospitalization time,and pathological results were recorded,and the cumulative sum(CUSUM)analysis was performed to evaluate the learning curve for *** According to the CUSUM analysis,the learning curve for GRPD was grouped into two phases:The early and late *** OT was 480±81.65 min vs 331±76.54 min,hospitalization time was 22±4.53 d vs 17±6.08 d,and blood loss was 308±54.78 mL vs 169.2±35.33 mL in the respective ***,including pancreatic fistula,bile leakage,reoperation rate,postoperative death,and delayed gastric emptying,were significantly decreased after this surgical *** GRPD can improve the learning curve and operative time,providing a new method for shortening the RPD learning curve.

关键词： Robotic pancreaticoduodenectomy “G”-shaped approach learning curve Cumulative sum analysis

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learning curve for magnetic resonance imaging/ultrasound fusion prostate biopsy in detecting prostate cancer using cumulative sum analysis

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Current Urology 2023年第3期17卷 159-164页

作者： Linhan Xu Nancy Yating Ye Adrianna Lee Jasleen Chopra Michael Naslund Jade Wong-You-Cheong Amelia Wnorowski Mohummad Minhaj Siddiqui University of Maryland School of Medicine BaltimoreMDUSA Division of Urology Department of General SurgeryKaiser Permanente Los Angeles Medical CenterLos AngelesCAUSA Department of Diagnostic Radiology University of Maryland School of MedicineBaltimoreMDUSA Division of Urology Department of SurgeryUniversity of Maryland School of MedicineUniversity of Maryland Medical CenterBaltimoreMDUSA

Background:Targeted magnetic resonance(MR)with ultrasound(US)fusion-guided biopsy has been shown to improve detection of prostate *** implementation of this approach requires integration of skills from radiologists and *** methods for assessment of learning curves,such as cumulative sum(CUSUM)analysis,may be helpful in identifying the presence and duration of a learning *** aim of this study is to determine the learning curve for MR/US fusion-guided biopsy in detecting clinically significant prostate cancer using CUSUM *** and methods:Retrospective analysis was performed in this institutional review board-approved *** urologists implemented an MR/US fusion-guided prostate biopsy program between March 2015 and September *** primary outcome measure was cancer detection rate(CDR)stratified by Prostate Imaging Reporting and Data System(PI-RADS)scores assigned on the MR *** sum analysis quantified actual cancer detection versus a predetermined target satisfactory CDR of MR/US fusion biopsies in a sequential case-by-case *** this analysis,satisfactory performance was defined as>80%CDR in patients with Pl-RADS 5,>50%in PI-RADS 4,andlearning curve analysis demonstrated intermittent underperformance until approximately 50 *** this inflection point,there was consistently good performance,evidence that no further learning curve was being ***:At a new center implementing MR/US fusion-guided prostate biopsy,the learning curve was approximately 50 cases before a consistently high performance for prostate cancer detection.

关键词： Cumulative sum analysis learning curve Magnetic resonance/ultrasound fusion biopsy Prostate cancer

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The learning curve for laparoscopic splenectomy for massive splenomegaly： a single surgeon＇s experience

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Chinese Medical Journal 2013年第11期126卷 2103-2108页

作者： WU Zhong ZHOU Jin CAI Yun-qiang LIU Shi-an PENG Bing Department of Hepato-Pancreatic-Biliary Surgery West ChinaHospital Sichuan University Chengdu Sichuan 610041 China Department of Gastrointestinal Surgery West China HospitalSichuan University Chengdu Sichuan 610041 China Department of Health Statistics West China School of Public HealthSichuan University Chengdu Sichuan 610041 China

Background Laparoscopic splenectomy （LS） for massive splenomegaly is more technically challenging than for a normal-sized spleen. The purpose of this study was to determine the effect of operative experience on perioperative outcomes of LS for massive splenomegaly. Methods Between January 2008 and December 2010, 36 consecutive patients who were diagnosed with massive splenomegaly underwent LS in our department. The perioperative outcomes were evaluated for evidence of a learning curve effect. Patients were divided into three groups （1, 2, and 3） of 12 consecutive patients, and outcomes of each group were compared. Results The mean operative time decreased significantly from 252 minutes of Group 1 to 179 minutes of Group 3. The estimated blood loss and length of post-operative hospital stay showed a similar trend. No significant differences were found in the splenic length and weight, transfusion rate, or average amount of drainage. In this cohort, there were three cases with surgical complications and one conversion to open laparotomy. Conclusions The first 24 cases constitute the early stage of the learning curve for LS for massive splenomegaly. LS for massive splenomegaly is a technically challenging operation with a long learning curve, and strategies for developing training programs must address these challenges.

关键词： laparoscopic splenectomy splenomegaly learning curve

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Does robot-assisted laparoscopic radical prostatectomy enable to obtain adequate oncological and functional outcomes during the learning curve?From the Korean experience

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Asian Journal of Andrology 2009年第2期11卷 167-175页

作者： Young Hwii Ko Jeong Hyeon Ban Seok Ho Kang Hong Seok Park Jeong Gu Lee Duck Ki Yoon Je Jong Kim Jun Cheon Vipul RPatel Department of Urology MIS&Robotic Urologic Surgery CenterKorea University School of MedicineSeoul 136705Korea Global Robotics Institute University of Central FloridaFlorida HospitalOrlandoFL 32803USA

To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy(RALRP)during the learning curve,in terms of surgical,oncological and functional outcomes,we conducted a prospective survey on *** July 2007,a single surgeon performed 63 robotic prostatectomies using the same operative *** data,including pathological and early functional results of the patient,were collected prospectively and *** with the accumulation of the cases,the total operative time,setup time,console time and blood loss were significantly *** major complication was present in any *** was needed in six patients;all of them were within the initial 15 *** positive surgical margin rate was 9.8%(5/51)in pT2 *** most frequent location of positive margin in this stage was the lateral aspect(60%),but in pT3 disease multiple margins were the most frequent(41.7%).Overall,53(84.1%)patients had totally continent status and the median time to continence was 6.56 *** 17 patients who maintained preoperative sexual activity(Sexual Health Inventory for Men≥17),stage below pT2,followed up for>6 months with minimally one side of neurovascular bundle preservation procedure,12(70.6%)were capable of intercourse postoperatively,and the mean time for sexual intercourse after operation was 5.7 *** this series,robotic prostatectomy was a feasible and reproducible technique,with a short learning curve and low perioperative complication *** during the initial phase of the learning curve,satisfactory results were obtained with regard to functional and oncological outcome.

关键词： learning curve outcomes assessment radical prostatectomy robotics

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