Learning Curve Analysis of Intracorporeal Cuff Suturing During Robotic Single-Site Total Hysterectomy

Akdemir, Ali; Zeybek, Burak; Ozgurel, Banu; Öztekin, Mehmet Kemal; Şendağ, Fatih

doi:10.1016/j.jmig.2014.06.006

Cited by 20 publications

(7 citation statements)

References 14 publications

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“…Although barbed sutures may be easier to use in single-site surgery, surgeons should develop skills for intracorporeal knot-tying for this platform. Akdemir et al applied a standardized intracorporeal cuff suture technique to 24 cases of robotic single-site total hysterectomy using intracorporeal interrupted single stitches with a 0 Vicryl suture with a 40-mm ½-circle cutting needle [ 46 ]. Using this technique, the surgeons found that the learning curve for intracorporeal suturing of the vaginal cuff in LESS reached a plateau at around 14 procedures, with a reduction of the average vaginal cuff closure time from 26.4 minutes in the first 14 cases to 18.7 minutes in the following 10 cases.…”

Section: Reviewmentioning

confidence: 99%

Vaginal Cuff Closure in Minimally Invasive Hysterectomy: A Review of Training, Techniques, and Materials

Smith¹,

Caceres²

2017

Cureus

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Hysterectomy is one of the most common surgeries performed each year and can be indicated for many gynecologic conditions. The development of minimally invasive surgery has transformed this procedure, resulting in improved outcomes, superior cosmesis, and quicker return to normal function. Vaginal cuff closure is a critical component of hysterectomy, with many variations in surgical technique and materials. This review provides an overview of intracorporeal suturing and knot-tying techniques at the level of a junior resident in obstetrics and gynecology and describes several validated models that have been developed to test resident skill level in vaginal cuff closure. We also provide a review of the literature regarding vaginal cuff closure techniques and suture materials, including knotless barbed sutures. Finally, a brief discussion of single-site surgery, the latest development in minimally invasive hysterectomy, will be provided. We hope to provide a better understanding of vaginal cuff closure for residents in the field of obstetrics and gynecology.

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Section: Reviewmentioning

confidence: 99%

Vaginal Cuff Closure in Minimally Invasive Hysterectomy: A Review of Training, Techniques, and Materials

Smith¹,

Caceres²

2017

Cureus

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“…More subgroups may predict the turning point more effectively, which represents the lowest case numbers or the shortest time required to learn a new technique, of the learning curve for a new technology; however, they may also reduce the reliability and validity of the analyses results because of the reduced size of each subgroup. In the power-law curve analysis [7], the relationship between the reduced operation time and the increased case numbers is assumed to follow a power-law distribution. However, the operator's stability cannot be evaluated from the regression curve, and the turning point may have advanced without achieving stability.…”

Section: Discussionmentioning

confidence: 99%

“…During the past two years, some studies have analyzed the different stages of robotic surgery; however, they analyzed only one of these stages [6, 7]. Therefore, the present study performed a stage-by-stage analysis of the learning curve for robotic-assisted laparoscopic hysterectomy to clearly understand the different stages.…”

Section: Introductionmentioning

confidence: 99%

Learning Curve Analysis of Different Stages of Robotic-Assisted Laparoscopic Hysterectomy

Tang

Tsai

2017

BioMed Research International

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Objective. To analyze the learning curves of the different stages of robotic-assisted laparoscopic hysterectomy. Design. Retrospective analysis. Design Classification. Canadian Task Force classification II-2. Setting. Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Patient Intervention. Women receiving robotic-assisted total and subtotal laparoscopic hysterectomies for benign conditions from May 1, 2013, to August 31, 2015. Measurements and Main Results. The mean age, body mass index (BMI), and uterine weight were 46.44 ± 5.31 years, 23.97 ± 4.75 kg/m2, and 435.48 ± 250.62 g, respectively. The most rapid learning curve was obtained for the main surgery console stage; eight experiences were required to achieve duration stability, and the time spent in this stage did not violate the control rules. The docking stage required 14 experiences to achieve duration stability, and the suture stage was the most difficult to master, requiring 26 experiences. BMI did not considerably affect the duration of the three stages. The uterine weight and the presence of adhesion did not substantially affect the main surgery console time. Conclusion. Different stages of robotic-assisted laparoscopic hysterectomy have different learning curves. The main surgery console stage has the most rapid learning curve, whereas the suture stage has the slowest learning curve.

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“…Afterwards, a circumferential colpotomy was performed using the monopolar instrument, the vaginal cuff was closed intracorporeally with intra-corporeal single stitches using da Vinci Single-Site Platform instruments in all cases. The RSS-TH surgical technique was described in detail in our previous reports [9,10,11]. …”

Section: Methodsmentioning

confidence: 99%

Single Incision Trans-Umbilical Total Hysterectomy: Robotic or Laparoscopic?

Akdemir¹,

Yıldırım

Zeybek³

et al. 2015

Gynecol Obstet Invest

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Objective: The aim of this study was to compare the early surgical outcomes in patients who underwent total hysterectomy with laparoendoscopic single-site surgery (LESS-TH) versus robotic single-site total hysterectomy (RSS-TH). Methods: Twenty-four patients who underwent RSS-TH and thirty-four patients who underwent LESS-TH were retrospectively evaluated. Patient characteristics, operation time, intraoperative data (conversions, complications, estimated blood loss, etc.) and postoperative pain scores were compared. Results: The total operation time was significantly longer in the robotic surgery group, with a time of 98.5 vs. 86 min (p = 0.013), while vaginal closure time was significantly higher in the laparoscopic surgery group (p = 0.011). Intraoperative outcomes and postoperative pain scores were similar in the two groups. Conclusion: RSS-TH helps surgeons to overcome the technical disadvantages of LESS-TH, particularly vaginal cuff closure, ergonomics and instrument crowding and clashing. Early surgical outcomes are comparable in the two groups, and both techniques are safe and feasible.

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Learning Curve Analysis of Intracorporeal Cuff Suturing During Robotic Single-Site Total Hysterectomy

Cited by 20 publications

References 14 publications

Vaginal Cuff Closure in Minimally Invasive Hysterectomy: A Review of Training, Techniques, and Materials

Vaginal Cuff Closure in Minimally Invasive Hysterectomy: A Review of Training, Techniques, and Materials

Learning Curve Analysis of Different Stages of Robotic-Assisted Laparoscopic Hysterectomy

Single Incision Trans-Umbilical Total Hysterectomy: Robotic or Laparoscopic?

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