Learning Curve Analysis of Laparoscopic Kasai Portoenterostomy

Ye, Yongqin; Wu, Zhouguang; Wang, Bin

doi:10.1089/lap.2016.0204

Cited by 17 publications

(7 citation statements)

References 11 publications

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“…The 50 cases of learning curve in our study was more than that reported by Li et al [ 19 ]. The authors drew the conclusion that without the usage of Cumulative sum analysis for ORT and Kaplan–Meier analysis for SNL.…”

Section: Discussioncontrasting

confidence: 41%

Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases

Yang

Zhang

et al. 2018

BMC Surg

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BackgroundLaparoscopic Kasai portoenterostomy (LKPE) is performed for biliary atresia (BA). As LKPE is a technically demanding operation, a learning curve should be defined to guide training. The aim of this study was to identify the learning curve of LKPE for BA.MethodsMetrics of perioperative safety and efficiency for 100 cases of LKPE were evaluated. Outcomes were followed to 67.2 ± 12.1 months. Cumulative sum (CUSUM) analysis was used to identify inflexion point corresponding to the learning curve. Outcome measures included operative time (ORT), rate of clearance of jaundice (CJ) and survival with native liver (SNL).ResultsBetween May 2009 and May 2013, 100 consecutive patients with BA underwent LKPE. The rate of conversion from LKPE to open Kasai portoenterostomy (OKPE), intraoperative transfusion and any perioperative complications was 11, 26 and 16%, respectively. There was no perioperative mortality. The CUSUM analysis revealed a learning curve of 50 for LKPE. Precipitous ORT reductions from an initial mean operative time of 316.3 min that was observed in the first 50 to 232.2 min of the late 50 cases (P < 0.01). Subsequently, cases 1 to 50 were considered ‘early experience’, whereas cases 51 and higher were considered as ‘late experience’ for statistical analysis. The rate of CJ and SNL was significantly higher after the early 50 cases (P < 0.05). In contrast, the rate of intraoperative transfusion, the median time of oral feeding initiated after operation, and the length of hospital stay was not different between the both groups (P > 0.05).ConclusionsIn this experience, improved perioperative and postoperative parameters for LKPE were observed in the last 50 patients when compared with the first 50 patients. The dedicated training is likely to contribute to significantly shorter learning curves in future adopters.

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Section: Discussioncontrasting

confidence: 41%

Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases

Yang

Zhang

et al. 2018

BMC Surg

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“…This was especially apparent for Kasai portoenterostomy, esophageal atresia repair, and pyloromyotomy. For example, during the learning curve for Kasai portoenterostomy in the presented series, the first-year native liver survival rate was 16 to 35% lower, 17,18 which translates to 8 to 14 patients requiring a liver transplant that potentially could have been avoided had the learning curve been completed already. Similarly, two to five patients undergoing n/a n/a n/a n/a n/a n/a…”

Section: Discussionmentioning

confidence: 85%

Minimally Invasive Pediatric Surgery: The Learning Curve

et al. 2020

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The use of minimally invasive surgery (MIS) in pediatric patients has increased over the past decades. The process of mastering a new procedure is termed the learning curve, during which the ability to operate increases but poorer outcomes are produced. We aim to analyze the current evidence on learning curves in pediatric MIS and evaluate its impact on patient's clinical outcomes. A systematic literature search was performed for studies listed on PubMed that reported on the learning curve for MIS surgical procedures. Studies were included if they stated the number of procedures required to reach a consistency in outcomes or if they compared outcomes between early and late period of MIS experience regarding the endpoints operative time, conversions, and intra-/postoperative complications. A total of 22 articles reporting on 11 surgical procedures were included in the study. Most authors reported a significant decrease in operative time as well as peri- and postoperative complications with increasing experience of the surgeon. Complications ranged from minor to major, the latter being especially severe for patients receiving pyloromyotomy (5–7% higher risk of mucosal perforation), esophageal atresia repair (15% higher leakage rate and 19–77% higher stenosis rate), or Kasai portoenterostomy (26–35% more liver transplants in the first year after surgery) during the learning curve period. Pediatric MIS comes with a considerable learning curve that may have a significant impact on the patient's clinical outcomes. Efforts should be made to minimize the effect of the learning curve on the patients.

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“…Лапароскопические операции позволяют минимизировать травматичность данной процедуры, сокращая использование наркотических анальгетиков и время пребывания ребенка на ИВЛ в послеоперационном периоде, также раньше начинается энтеральная нагрузка [46,48,49,50]. По своей эффективности лапароскопические операции не уступают открытым операциям [46] и одним немаловажным фактом является то, что количество хирургических осложнений после данной методики меньше, чем после открытых операций [49,51] Про расширенную портоэнтеростомию Davenport at al. [15,58] сообщают, что радикальное иссечение всех внепеченочных желчных протоков и широкая портоэнтеростомия, охватывающая все резецированные участки, в которые возможно открываются необлитерированные желчные протоки, являются обязательными, несмотря на трудоемкую и кропотливую технику выполнения.…”

Section: лечение баunclassified

“…При III типе атрезии желчных ходов годичная выживаемость находится в диапазоне от 50% до 76,2% [51,53,57], частота встречаемости холангитов в раннем послеоперационном периоде варьирует от 18,7% до 43,7%, а 5-ти летняя выживаемость составляет 47,1% [43].…”

Section: анатомо-морфологические особенности баunclassified

Modern Approaches to the Surgical Treatment of Biliary Atresia

Разумовский

Ratnikov

2018

jour

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The review of literature deals with the current classification of the biliary atresia, presents the authors’ opinion considering a technique of theKasaiprocedure, and displays modern modifications of portoenteroanastomosis estimating their effectiveness. PubMed database and Google Scholar search system were used to search for primary terms. Survival of children with this pathology was analyzed depending on theKasaitechnique, anatomical form, terms of portoenteroanastomosis and importance of early diagnosis of this pathology.

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Learning Curve Analysis of Laparoscopic Kasai Portoenterostomy

Abstract: A surgeon is able to become more experienced after performing approximately 40 laparoscopic Kasai Portoenterostomys.

Cited by 17 publications

References 11 publications

Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases

Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases

Minimally Invasive Pediatric Surgery: The Learning Curve

Modern Approaches to the Surgical Treatment of Biliary Atresia

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