Impact of First Assistant Surgeon Experience on the Perioperative Outcomes of Laparoscopic Hepatectomies

PurposeRecently, totally laparoscopic ileostomy reversal (TLAP) has received increasing attention and exhibited promising short-term outcomes. The aim of this study was to detail the learning process of the TLAP technique.MethodsBased on our initial experience with TLAP from 2018, a total of 65 TLAP cases were enrolled. Demographics and perioperative parameters were assessed using cumulative sum (CUSUM), moving average, and risk-adjusted CUSUM (RA-CUSUM) analyses.ResultsThe overall mean operative time (OT) was 94 min and the median postoperative hospitalization period was 4 days, and there was an estimated 10.77% incidence rate of perioperative complications. Three unique phases of the learning curve were derived from CUSUM analysis, and the mean OT of phase I (1–24 cases) was 108.5 min, that of phase II (25–39 cases) was 92 min, and that of phase III (40–65 cases) was 80 min, respectively. There was no significant difference in perioperative complications between these 3 phases. Similarly, moving average analysis indicated that the operation time was reduced significantly after the 20th case and reached a steady state after the 36th case. Furthermore, complication-based CUSUM and RA-CUSUM analyses indicated an acceptable range of complication rates during the whole learning period.ConclusionOur data demonstrated 3 distinct phases of the learning curve of TLAP. For an experienced surgeon, surgical competence in TLAP can be grasped at around 25 cases with satisfactory short-term outcomes.

Section: Discussionmentioning

confidence: 80%

A multidimensional learning curve analysis of totally laparoscopic ileostomy reversal using a single surgeon' s experience

Zheng

Zhang

et al. 2023

Front. Surg.

“…In surgeries for benign diseases, Tarik et al reported that the training level of the first assistant in bariatric procedures did not negatively affect the occurrence of serious perioperative complications [21]. In surgeries for malignant diseases, comparable results have been reported in laparoscopic sigmoidectomies and laparoscopic hepatectomies [14,22].…”

Section: Discussionmentioning

confidence: 93%

“…A primary surgeon may experience stress when working with an inexperienced assistant [ 14 ]. Cai et al described potential reasons why surgery with an inexperienced assistant does not affect the morbidity of complications [ 22 ]. First, the lack of experience of the first assistant surgeon could be offset by the rest of the surgical team.…”

Section: Discussionmentioning

confidence: 99%

Does the experience of the first assistant affect organ injuries in laparoscopic hysterectomy for benign diseases?

Hirata

et al. 2022

Arch Gynecol Obstet

Purpose This study sought to explore whether the experience level of the first assistant surgeon influences perioperative organ injuries (ureteral, bladder, and intestinal injuries) in patients undergoing total laparoscopic hysterectomy (TLH) for benign diseases. We defined an experienced surgeon as a surgeon certified by the Skill Qualification Committee of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy or a surgeon with equivalent surgical skills. Methods We reviewed our surgical registry database of TLH for benign indications between 2014 and 2020 and only selected cases performed by an experienced primary surgeon. Patients were divided into two groups based on the experience level of the first assistant. Inverse probability of treatment weighting by propensity score, which was adjusted for patient and procedure characteristics, was used to examine differences in perioperative organ injuries according to the experience level of the first assistant. Results Among 1682 patients who underwent TLH, 18 organ injuries were found (0.83%). In the propensity score inverse probability of treatment weighting models, less experience of the first assistant had no significant impact on the occurrence of perioperative organ injuries (p = 0.348). Conclusion In TLH for benign indications at our hospital, given an experienced primary surgeon, the inclusion of a less experienced first assistant does not negatively affect the occurrence of perioperative organ injuries.

“…In surgeries for benign diseases, Tarik et al reported that the training level of the rst assistant in bariatric procedures did not negatively affect the occurrence of serious perioperative complications [19]. In surgeries for malignant diseases, comparable results have been reported in laparoscopic sigmoidectomies and laparoscopic hepatectomies [12,20].…”

Section: Discussionmentioning

confidence: 93%

“…A primary surgeon may experience stress when working with an inexperienced assistant [12]. Cai et al described potential reasons why surgery with an inexperienced assistant does not affect the morbidity of complications [20]. First, the lack of experience of the rst assistant surgeon could be offset by the rest of the surgical team.…”

Section: Discussionmentioning

confidence: 99%

Does the experience of the first assistant affect organ injuries in laparoscopic hysterectomy for benign diseases?

Hirata

et al. 2022

Preprint

Purpose: This study sought to explore whether the experience level of the first assistant surgeon influences perioperative organ injuries (ureteral, bladder, and intestinal injuries) in patients undergoing total laparoscopic hysterectomy (TLH) for benign diseases. We defined an experienced surgeon as a surgeon certified by the Skill Qualification Committee of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy or a surgeon with equivalent surgical skills.Methods. We reviewed our surgical registry database of TLH for benign indications between 2014 and 2020 and only selected cases performed by an experienced primary surgeon. Patients were divided into two groups based on the experience level of the first assistant. Inverse probability of treatment weighting by propensity score, which was adjusted for patient and procedure characteristics, was used to examine differences in perioperative organ injuries according to the experience level of the first assistant.Results. Among 1,682 patients who underwent TLH, 18 organ injuries were found (0.83%). In the propensity score inverse probability of treatment weighting models, less experience of the first assistant had no significant impact on the occurrence of perioperative organ injuries (p = 0.348).Conclusion. In TLH for benign indications at our hospital, given an experienced primary surgeon, the inclusion of a less experienced first assistant does not negatively affect the occurrence of perioperative organ injuries.