Procedure-specific Training for Robot-assisted Distal Pancreatectomy

Klompmaker, Sjors; Vliet, Walderik J. van der; Thoolen, Stijn J.J.; Ore, Ana Sofia; Verkoulen, Koen; Solis-Velasco, Monica; Canacari, Elena; Kruskal, Jonathan B.; Khwaja, Khalid; Tseng, Jennifer F.; Callery, Mark P.; Kent, Tara S.; Moser, A. James

doi:10.1097/sla.0000000000003291

Cited by 15 publications

(17 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, several other studies also reported longer operating times for minimally invasive hepatobiliary surgery. 52,53 However, operating time decreased when the surgeon had overcome the learning curve and is considered proficient in minimally invasive hepatobiliary surgery. 53 Finally, length of stay was reduced in the LH group.…”

Section: Discussionmentioning

confidence: 99%

“…52,53 However, operating time decreased when the surgeon had overcome the learning curve and is considered proficient in minimally invasive hepatobiliary surgery. 53 Finally, length of stay was reduced in the LH group. Statistical heterogeneity of this outcome can be attributed to the international variety of studies, where different discharge management is maintained.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Short-term outcomes of laparoscopic versus open hepatectomy in the elderly patient: systematic review and meta-analysis

Hildebrand

Verkoulen

Dewulf

et al. 2021

HPB

Self Cite

View full text Add to dashboard Cite

Background and aim: Favorable outcomes of laparoscopic hepatectomy (LH) over open hepatectomy (OH) have been demonstrated. LH offers less postoperative morbidity, less blood loss and shorter hospital stay, while maintaining oncological safety. Only limited evidence about outcomes of LH in elderly is currently available. Therefore, this study aimed to compare short term outcomes of LH to OH for patients >65 years. Methods: A systematic review and meta-analysis were performed according to Cochrane guidelines. Embase, PubMed, Cochrane Library, and Google Scholar were searched to identify eligible studies. Studies were included if they compared LH to OH, and focused on an elderly population, or had a majority of patients >65 years. Perioperative and postoperative outcomes were analyzed. Results: Thirteen studies with 1174 patients (LH:532, OH:642) were included for analysis. When compared to OH, elderly undergoing LH had significantly less postoperative complications (relative risk [RR]0.52; 95% confidence interval (CI):0.43-0.63), less blood loss (mean difference [MD]-198.58; 95% CI:-299.88 to −97.28), and shorter length of stay (MD-4.83; 95%CI:-7.91 to −1.84), while oncological safety was non-inferior (RR1.04; 95%CI:1.00-1.08). Conclusions: Within the elderly population LH seems to be superior to OH, concerning short-term outcomes. However, for broader applicability more trials are needed including more difficult and major resections.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Short-term outcomes of laparoscopic versus open hepatectomy in the elderly patient: systematic review and meta-analysis

Hildebrand

Verkoulen

Dewulf

et al. 2021

HPB

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although robotic assistance during MIPD may contribute to overcoming several aspects of technical difficulty in LPD, RPD also requires enough time and experience to reach proficiency. There are still a limited number of learning curve analyses in RPD and RDP 40,43,66–68 . From these observational studies, experience with at least 20‐40 robot‐assisted pancreatic surgeries is required for the initial advance in the techniques.…”

Section: Learning Curve Analysis and Hospital Volumementioning

confidence: 99%

“…[27][28][29] In the LPD learning curve, related improvement in surgical outcomes of the operative time and blood loss was seen after 30-50 cases 53,61-65 (Table 2). For robot-assisted pancreatic resections (RDP and RPD), 20-40 cases have been proposed as being needed to overcome the learning curve as an initial progress 40,43,[66][67][68][69] (Table 2). From these learning curve analyses, an experienced surgeon may be defined as a surgeon who has experienced 20 cases in LDP and 30 cases in LPD.…”

Section: Le Arning Curve Analys Is and Hos Pital Volumementioning

confidence: 99%

Current statement and safe implementation of minimally invasive surgery in the pancreas

Hayashi

Baba

2020

Annals of Gastroent Surgery

View full text Add to dashboard Cite

Minimally invasive pancreatic resection (MIPR) has become very popular even in pancreatic surgery. Laparoscopic pancreatoduodenectomy (LPD) and laparoscopic distal pancreatectomy (LDP) were introduced in 1994 and 1996, respectively. 1,2 Robotic surgical systems had also already been established 20 years ago, and the first case of robotic distal pancreatectomy (RDP) was reported in 2002. 3 Nowadays, laparoscopic and robotic approaches are becoming popular in MIPR, and the Miami international evidence-based guidelines on MIPR were announced in 2020. 4 In the guidelines, minimally invasive distal pancreatectomy (MIDP) for benign and low-grade malignant tumors established a secure position over open distal pancreatectomy (ODP), since the former is associated with a shorter

show abstract

“…As such, a first step in measuring the real-time efficiency and identifying bottlenecks in NGS and bioinformatics pipelines could be to adopt statistical process control (SPC) methods such as cumulative sum (CUSUM) (14), or exponentially weighted moving average (EWMA) (15), to monitor the temporal parameter stability and identify structural breakpoints in TAT. CUSUM is a sequential analysis technique which monitors change detection, particularly deviation from a performance standard (16)(17)(18), and has been widely used in a range of healthcare settings, from describing the learning curves of surgical or procedural skills (19)(20)(21)(22)(23)(24), to clinical audits (25)(26)(27), and quality-assurance studies (22,(28)(29)(30)(31)(32). Similar to CUSUM, EWMA control charts have been widely used for measuring and monitoring healthcare outcomes (33,34).…”

Section: Introductionmentioning

confidence: 99%

Statistical Process Control Charts for Monitoring Next-Generation Sequencing and Bioinformatics Turnaround in Precision Medicine Initiatives

Jain

Sim

et al. 2021

Front. Oncol.

View full text Add to dashboard Cite

PurposePrecision oncology, such as next generation sequencing (NGS) molecular analysis and bioinformatics are used to guide targeted therapies. The laboratory turnaround time (TAT) is a key performance indicator of laboratory performance. This study aims to formally apply statistical process control (SPC) methods such as CUSUM and EWMA to a precision medicine programme to analyze the learning curves of NGS and bioinformatics processes.Patients and MethodsTrends in NGS and bioinformatics TAT were analyzed using simple regression models with TAT as the dependent variable and chronologically-ordered case number as the independent variable. The M-estimator “robust” regression and negative binomial regression were chosen to serve as sensitivity analyses to each other. Next, two popular statistical process control (SPC) approaches which are CUSUM and EWMA were utilized and the CUSUM log-likelihood ratio (LLR) charts were also generated. All statistical analyses were done in Stata version 16.0 (StataCorp), and nominal P < 0.05 was considered to be statistically significant.ResultsA total of 365 patients underwent successful molecular profiling. Both the robust linear model and negative binomial model showed statistically significant reductions in TAT with accumulating experience. The EWMA and CUSUM charts of overall TAT largely corresponded except that the EWMA chart consistently decreased while the CUSUM analyses indicated improvement only after a nadir at the 82nd case. CUSUM analysis found that the bioinformatics team took a lower number of cases (54 cases) to overcome the learning curve compared to the NGS team (85 cases).ConclusionAs NGS and bioinformatics lead precision oncology into the forefront of cancer management, characterizing the TAT of NGS and bioinformatics processes improves the timeliness of data output by potentially spotlighting problems early for rectification, thereby improving care delivery.

show abstract

Procedure-specific Training for Robot-assisted Distal Pancreatectomy

Abstract: Supplemental Digital Content is available in the text

Cited by 15 publications

References 53 publications

Short-term outcomes of laparoscopic versus open hepatectomy in the elderly patient: systematic review and meta-analysis

Short-term outcomes of laparoscopic versus open hepatectomy in the elderly patient: systematic review and meta-analysis

Current statement and safe implementation of minimally invasive surgery in the pancreas

Statistical Process Control Charts for Monitoring Next-Generation Sequencing and Bioinformatics Turnaround in Precision Medicine Initiatives

Contact Info

Product

Resources

About