Application of the Statistical Process Control Method for Prospective Patient Safety Monitoring During the Learning Phase: Robotic Kidney Transplantation with Regional Hypothermia (IDEAL Phase 2a–b)

Sood, Akshay; Ghani, Khurshid R.; Ahlawat, Rajesh; Modi, Pranjal; Abaza, Ronney; Jeong, Wooju; Sammon, Jesse D.; Diaz, Mireya; Kher, Vijay; Menon, Mani; Bhandari, Mahendra

doi:10.1016/j.eururo.2014.02.055

Cited by 65 publications

(48 citation statements)

References 27 publications

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“…These terms, however, were used inconsistently or interchangeably 36,50 , or used with distinct definitions 33,49 . These terms, however, were used inconsistently or interchangeably 36,50 , or used with distinct definitions 33,49 .…”

Section: Discussionmentioning

confidence: 99%

“…In 13 of 14 studies (93 per cent) that employed performance terms, at least one term was used to describe the point where the learning curve had been overcome; 'proficiency' was used for this purpose in ten studies 22,27,28,31,36,38,39,42,50,55 , 'competency' in five studies 10,27,33,36,49 and 'expertise' in one study 50 . However, these terms were used inconsistently.…”

Section: Standards Of Reportingmentioning

confidence: 99%

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Systematic review of learning curves in robot-assisted surgery

et al. 2020

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Background: Increased uptake of robotic surgery has led to interest in learning curves for robot-assisted procedures. Learning curves, however, are often poorly defined. This systematic review was conducted to identify the available evidence investigating surgeon learning curves in robot-assisted surgery.Methods: MEDLINE, Embase and the Cochrane Library were searched in February 2018, in accordance with PRISMA guidelines, alongside hand searches of key congresses and existing reviews. Eligible articles were those assessing learning curves associated with robot-assisted surgery in patients.Results: Searches identified 2316 records, of which 68 met the eligibility criteria, reporting on 68 unique studies. Of these, 49 assessed learning curves based on patient data across ten surgical specialties. All 49 were observational, largely single-arm (35 of 49, 71 per cent) and included few surgeons. Learning curves exhibited substantial heterogeneity, varying between procedures, studies and metrics. Standards of reporting were generally poor, with only 17 of 49 (35 per cent) quantifying previous experience. Methods used to assess the learning curve were heterogeneous, often lacking statistical validation and using ambiguous terminology.Conclusion: Learning curve estimates were subject to considerable uncertainty. Robust evidence was lacking, owing to limitations in study design, frequent reporting gaps and substantial heterogeneity in the methods used to assess learning curves. The opportunity remains for the establishment of optimal quantitative methods for the assessment of learning curves, to inform surgical training programmes and improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Standards Of Reportingmentioning

confidence: 99%

Systematic review of learning curves in robot-assisted surgery

et al. 2020

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“…[1][2][3] Several studies have demonstrated a relationship between surgeon experience and outcomes in minimally-invasive prostate surgery. 4,5 Discrepancies in patient outcomes also lie in the hospital characteristics, with high-volume and teaching hospitals providing better quality care.…”

Section: Introductionmentioning

confidence: 99%

The impact of resident involvement in minimally-invasive urologic oncology procedures

Ruhotina¹,

Dagenais²,

Gandaglia³

et al. 2014

CUAJ

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Introduction: Robotic and laparoscopic surgical training is an integral part of resident education in urology, yet the effect of resident involvement on outcomes of minimally-invasive urologic procedures remains largely unknown. We assess the impact of resident participation on surgical outcomes using a large multi-institutional prospective database. Methods: Relying on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2005Files ( -2011, we abstracted the 3 most frequently performed minimally-invasive urologic oncology procedures. These included radical prostatectomy, radical nephrectomy and partial nephrectomy. Multivariable logistic regression models were constructed to assess the impact of trainee involvement (PGY 1-2: junior, PGY 3-4: senior, PGY ≥5: chief) versus attending-only on operative time, length-of-stay, 30-day complication, reoperation and readmission rates. Results: A total of 5459 minimally-invasive radical prostatectomies, 1740 minimally-invasive radical nephrectomies and 786 minimally-invasive partial nephrectomies were performed during the study period, for which data on resident surgeon involvement was available. In multivariable analyses, resident involvement was not associated with increased odds of overall complications, reoperation, or readmission rates for minimally-invasive prostatectomy, radical and partial nephrectomy. However, operative time was prolonged when residents were involved irrespective of the type of procedure. Length-of-stay was decreased with senior resident involvement in minimally-invasive partial nephrectomies (odds ratio [OR] 0.49, p = 0.04) and prostatectomies (OR 0.68, p = 0.01). The major limitations of this study include its retrospective observational design, inability to adjust for the case complexity and surgeon/hospital characteristics, and the lack of information regarding the minimally-invasive approach utilized (whether robotic or laparoscopic). Conclusions:Resident involvement is associated with increased operative time in minimally-invasive urologic oncology procedures. However, it does not adversely affect the complication, reoperation or readmission rates, as well as length-of-stay.

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“…Robotics has since permeated and found its application in many oncologic, 23,24 nononcologic, 25,26 and pediatric [27][28][29] urologic procedures, and, more recently, in kidney transplantation. [30][31][32][33] …”

Section: Historical Perspectivementioning

confidence: 99%