Surgeon Learning Curves with Sentinel Lymph Node Detection

Abstract

bag. Pre-operative, intra-operative and post-operative data was collected including morcellation time, complications and pain scores up to 6 weeks post-operatively. Measurements/Results: Sixty patients total were enrolled. Fourteen patients (23%) had a hysterectomy, and 46 (77%) underwent a myomectomy. The average BMI was 27.9 (Range 17.5-40.1), the average morcellation time was 26.3 minutes (Range 9-74 mins). There were two intra-operative complications, one that occurred during placement of the sac that had no sequelae after observation and the second complication was unrelated to the morcellation process. There were 5 post-operative complications, 4 of them were Clavien-Dindo Grade 1, and 1 was a Clavien-Dindo Grade 3. Average pain score immediately post-operatively was 4.6 (Range 0 (no pain) -10 (severe pain)), and at post-operative week 4 average score was 0.56 (Min 0-Max 5). The average specimen weight was 370g (Range 41-1675g) and all specimens (100%) were benign. All bags maintained integrity during the procedure and post-operatively when tested using dyed albumin instillation. Conclusions: This novel sac is safe to use for contained laparoscopic power morcellation in a multi-port procedure. There were minimal complications and no evidence of bag disruption.

Defining the learning curve for successful staging with sentinel lymph node biopsy for endometrial cancer among surgeons at an academic institution

“…Multiple prospective studies have shown that SLN mapping and detection rates improve with surgeon experience,8 9 with 72% bilateral mapping success seen after 30 cases 9. Khoury-Collado et al8 found that after the first 30 cases, the SLN detection rate (defined as the identification of a SLN) increased from 77% to 94% (P=0.03).…”

“…The reported SLN detection rate in endometrial cancer staging is 23–100%, with a pooled averaged of 81%; success of bilateral mapping is 6–88%, with a pooled average of 50% 7. Although the literature is limited, increasing surgical volume appears to increase the rate of successful SLN mapping in endometrial cancer among experienced surgeons, with an increase in detection rate after 20–30 cases 8 9…”

Sentinel lymph node biopsy in early stage cervical cancer: A meta‐analysis

“…Inclusion criteria: 1) Official publication in English language, 2) Patients with cervical cancer (FIGO ⅠA~ⅡB, in which patients in IA1 had the complication of lymph vascular space invasion), 3) Sample size ≥30 cases (experienced learning curve), 7 4) Laparotomy or laparoscopic surgery, 5) The methods were SLNB using blue dye, 99m Tc, combined technique (blue dye with 99m Tc) or ICG. If multiple detection methods were used simultaneously in an article, the subgroup with sample size≥30 cases was included in the study.…”