Laparoscopic Pectopexy—CUSUM Learning Curve and Perioperative Complications Analysis

Szymczak, Paulina; Grzybowska, Magdalena Emilia; Sawicki, Sambor; Wydra, Dariusz

doi:10.3390/jcm10051052

Cited by 16 publications

(21 citation statements)

References 30 publications

(35 reference statements)

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“…The robotic sacrocolpopexy calculated proficiency in approximately 78 cases based on intraoperative complications 6 . The laparoscopic pectopexy calculated proficiency by CUSUM based on the operation time, blood loss, and length of hospital stay 7 . Nevertheless, few studies have calculated the learning curve of the vaginal route.…”

Section: Discussionmentioning

confidence: 99%

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Analyzing the learning curve of vaginal pelvic reconstruction surgery with and without mesh by the cumulative summation test (CUSUM)

Huang

Chang

et al. 2022

Sci Rep

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Women who underwent vaginal pelvic reconstructive surgery with or without mesh consecutively between 2004 and 2018 were retrospectively analyzed to determine the learning curve in vaginal pelvic reconstructive surgery. With cumulative summation (CUSUM) analysis of surgical failure and operation time, we assessed the learning curve of vaginal pelvic reconstructive surgery, including sacrospinous ligament fixation, anterior colporrhaphy, posterior colporrhaphy, and optional vaginal hysterectomy with or without mesh placement. The study is based on two individual surgeons who performed vaginal pelvic reconstructive surgery with or without mesh. Two hundred and sixty-four women with stage III or IV pelvic organ prolapse underwent vaginal pelvic reconstructive surgery by surgeons A or B. The median follow-up time of 44 months ranged from 24 to 120 months. Surgical proficiency was achieved in 32–33 vaginal pelvic reconstructive surgery procedures without mesh and 37–47 procedures in the same surgery with mesh. The total surgical success rates for surgeons A and B were 82.2% and 94.1%, with median follow-up times of 60 and 33 months, respectively. More procedures were needed for the learning curve of vaginal pelvic reconstructive surgery with mesh. Having crossed the proficiency boundary, the surgical success rate and operation time were improved.

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Section: Discussionmentioning

confidence: 99%

“…Pelvic reconstructive surgeries can be divided into vaginal and abdominal approaches. Two studies calculated the learning curve of laparoscopic and robotic pelvic reconstructive procedures 6 , 7 . Very little data regarding vaginal procedures are available.…”

Section: Introductionmentioning

confidence: 99%

Analyzing the learning curve of vaginal pelvic reconstruction surgery with and without mesh by the cumulative summation test (CUSUM)

Huang

Chang

et al. 2022

Sci Rep

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“…Therefore, the fluctuation could be avoided in the process of surgeons learning a new operation, and the degree of mastery of the operation could be more accurately judged. CUSUM method gradually has become an objective evaluation standard in the field of surgical medicine, which is used to investigate the minimum number of surgical cases required to learn new technology Braca 2021;He 2021;Kudsi 2021;Lee 2021;Lenfant 2021;Szymczak 2021;Toennesen 2021;Verhaeghe 2021]. In this study, the learning curves of the two methods systematically were analyzed.…”

Section: E95mentioning

confidence: 99%

“…By accumulating the clinical data information of each patient in a treatment, the CUSUM analysis accumulate the biased data to achieve the amplification effect, and the improved sensitivity of detecting the biased data in the treatment has been achieved. In recent years, CUSUM has been more and more widely used in the analysis of clinical surgery, while few studies involving macrovascular diseases Braca 2021;He 2021;Kudsi 2021;Lee 2021;Lenfant 2021;Szymczak 2021;Toennesen 2021; Verhaeghe 2021]. And the comparison of learning curve effect between hemi-arch replacement and total-arch replacement in the treatment of TAAD has not been systematically studied.…”

Section: Introductionmentioning

confidence: 99%

Learning Curve of Aortic Arch Replacement Surgery in Chinese Mainland with Stanford Type A Aortic Dissection

Sun

Fan²,

Dong

et al. 2022

HSF

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Background: Stanford type A aortic dissection (TAAD) is the most common cause of death caused by aortic disease in the Chinese mainland. Patients suffering TAAD need immediate surgical treatment [Pompilio 2001; Di Eusanio 2003; Ueda 2003; Li 2013; Afifi 2016; Zhou 2019; Zhou 2021]. Emergency aortic arch replacement is difficult and risky. The prognosis following surgery varies depending on the different surgical approaches [Pompilio 2001; Kazui 2002; Di Eusanio 2003; Ueda 2003; Moon 2009; Li 2013; Afifi 2016; Zhou 2019; Zhou 2021]. Aortic arch replacement includes total-arch replacement (Sun's operation) and hemi-arch replacement. The comparative analysis of learning curves between the two procedures has not been systematically studied. In this study, we studied and analyzed the learning curves of total-arch replacement and hemi-arch replacement using cumulative sum (CUSUM) analysis. Methods: From January 2013 to December 2019, a total of 139 Stanford TAAD operations were performed by the same surgeon and two assistants, including 61 cases of hemi-arch replacement and 78 cases of total-arch replacement. Baseline information, including preoperative conditions, intraoperative related data and postoperative prognosis, were collected. Descriptive statistics and CUSUM were used to analyze the total operation time, cardiopulmonary bypass (CPB) time, aortic clamping (AC) time, operative mortality, incidence of postoperative complications, postoperative intensive care unit (ICU) time, hospital stay, and postoperative drainage volume. Results: A total of 139 patients with TAAD (age 48.8 ± 12.3, male, 107, female, 32) underwent emergency aortic arch replacement. A total of 61 patients (43.9%) underwent hemi-arch replacement, and 78 patients (56.1%) underwent total-arch replacement. The total time, cardiopulmonary bypass (CPB) time, and aortic clamping (AC) time of hemi-arch operation were 434.2 ± 137.0 minutes, 243.3 ± 87.2 minutes, and 157.0 ± 60.2 minutes. The total, CPB, and AC times of total-arch operation were 747.8 ± 164.3 minutes, 476.4 ± 121.6 minutes, and 238.5 ± 67.6 minutes. The mortality of hemi-arch operation was 3.3%, and that of total-arch operation was 6.4%. The incidence of complications after hemi-arch operation was 11.3%, and that after total-arch operation was 46.2%. The ICU time and hospital stay after hemi-arch surgery were 7.3 ± 4.4 days and 27.2 ± 16.2 days, respectively, and the ICU time and total hospital stay after total-arch surgery were 7.2 ± 5.9 days and 24.0 ± 10.3 days, respectively. The total drainage volume after hemi-arch operation was 2182.4 ± 1236.4 ml, and that after total-arch operation was 2467.3 ± 1385.7 ml. According to CUSUM analysis, the same cardiovascular surgery team seems to have different learning curves in the time of two operations. CUSUM analysis of intraoperative and postoperative indicators shows that after a certain period of professional and systematic cardiovascular surgery training, aortic hemi-arch replacement has the characteristics of short learning cycle and easy to master for surgeons, while total-arch replacement requires a longer learning cycle. Conclusions: Although the emergency operation of TAAD is difficult and risky, according to results the of CUSUM analysis, cardiovascular surgeons can achieve better learning results in hemi-arch replacement than total-arch replacement.

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“…Pelvic reconstructive surgeries can be divided into vaginal and abdominal approaches. Two studies calculated the learning curve of laparoscopic and robotic pelvic reconstructive procedures 6,7 . Very little data regarding the vagnal approach are available.…”

Section: Introductionmentioning

confidence: 99%

The Learning Curve in Vaginal Pelvic Reconstruction Surgery for Severe Pelvic Organ Prolapse: Analysis of the Cumulative Summation Test (CUSUM)

Huang

Chang

et al. 2021

Preprint

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Women who underwent vaginal pelvic reconstructive surgery with or without mesh consecutively between 2004 and 2018 were retrospectively analyzed to determine the learning curve in vaginal pelvic reconstructive surgery. With cumulative summation (CUSUM) analysis of surgical failure and operation time, we assessed the learning curve of vaginal pelvic reconstructive surgery, including sacrospinous ligament fixation, anterior colporrhaphy, posterior colporrhaphy, and optional vaginal hysterectomy with or without mesh placement. Two hundred and sixty-four women with stage III or IV pelvic organ prolapse underwent vaginal pelvic reconstructive surgery by surgeon A or B. The median follow-up time of 44 months ranged from 24 to 120 months. Surgical proficiency was achieved in 32-54 vaginal pelvic reconstructive surgery procedures without mesh and 37-61 procedures in the same surgery with mesh. The surgical success rates for surgeons A and B were 82.2% and 94.1%, with median follow-up times of 60 and 33 months, respectively. The learning phase of vaginal pelvic reconstructive surgery in advanced pelvic organ prolapse in this institutional cohort required 54 and 61 procedures, respectively. A higher number of procedures were required for the learning curve of vaginal pelvic reconstructive surgery with mesh. Having crossed the boundary of proficiency, the surgical success rate and operation time were improved.

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Laparoscopic Pectopexy—CUSUM Learning Curve and Perioperative Complications Analysis

Cited by 16 publications

References 30 publications

Analyzing the learning curve of vaginal pelvic reconstruction surgery with and without mesh by the cumulative summation test (CUSUM)

Analyzing the learning curve of vaginal pelvic reconstruction surgery with and without mesh by the cumulative summation test (CUSUM)

Learning Curve of Aortic Arch Replacement Surgery in Chinese Mainland with Stanford Type A Aortic Dissection

The Learning Curve in Vaginal Pelvic Reconstruction Surgery for Severe Pelvic Organ Prolapse: Analysis of the Cumulative Summation Test (CUSUM)

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