Technical Performance as a Predictor of Clinical Outcomes in Laparoscopic Gastric Cancer Surgery

Fecso, Andras B.; Bhatti, Junaid; Stotland, Peter; Quereshy, Fayez A.; Grantcharov, Teodor P.

doi:10.1097/sla.0000000000002741

Cited by 59 publications

(66 citation statements)

References 39 publications

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“…Previous work has shown that technical performance assessed by GERT predicts outcomes in laparoscopic surgery. 9 Not all technical errors lead to intraoperative events. The identification and root cause analysis of technical errors is critical in preventing the occurrence of intraoperative events and mitigating the likelihood of postoperative complications and clinically significant adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

Assessment of 3-Dimensional vs 2-Dimensional Imaging and Technical Performance Using a Multiport Intraoperative Data Capture and Analytic System for Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass Surgery

et al. 2020

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IMPORTANCE Errors and adverse events occur frequently in health care. Three-dimensional (3-D) laparoscopic systems claim to provide more realistic depth perception and better spatial orientation compared with their 2-D counterparts. OBJECTIVE To compare the association of 3-D vs 2-D systems with technical performance during laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures using a multiport intraoperative data capture system. DESIGN, SETTING, AND PARTICIPANTS This cohort study was performed between May and December 2018, with a total of 50 LRYGB procedures performed in an academic tertiary care center; recordings of the operations were evaluated with a 30-day follow-up. All procedures were performed by the same surgical team. EXPOSURE Surgical teams used 2-D or 3-D laparoscopic systems. MAIN OUTCOMES AND MEASURES Technical performance was evaluated using the Objective Structured Assessment of Technical Skill and surgical errors and events using the Generic Error Rating Tool. RESULTS Of the 50 patients who underwent LRYGB procedures, 42 (86%) were women, with a median (interquartile range) age of 42 (35-47) years and a median (interquartile range) body mass index of 46 (42-48), with no significant demographic differences between the groups whose operations were performed using the 2-D and 3-D systems. The mean (SD) number of errors per case was significantly lower in procedures using the 3-D laparoscopic system than in those using the 2-D system (17 [6] vs 33 [2]; P < .001). The mean (SD) number of error-related events was significantly lower in procedures using the 3-D system than in those using the 2-D system (6 [2] vs 11 [4]; P < .001). Mean (SD) Objective Structured Assessment of Technical Skill scores were significantly higher when the 3-D system was used than when the 2-D system was used (28 [4] vs 22 [3]; P < .001). CONCLUSIONS AND RELEVANCE In this limited sample of LRYGB procedures, the use of a 3-D laparoscopic system was associated with a statistically significant reduction in errors and events as well as higher Objective Structured Assessment of Technical Skill scores compared with 2-D systems.

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Section: Introductionmentioning

confidence: 99%

Assessment of 3-Dimensional vs 2-Dimensional Imaging and Technical Performance Using a Multiport Intraoperative Data Capture and Analytic System for Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass Surgery

et al. 2020

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“…When we conduct comparative studies among surgical procedures, the skill of surgeons is a confounding factor 1,3,[5][6][7] . However, this important factor has often not been adjusted for in previous studies due to difficulties in measuring the surgical skill or performance in each case.…”

Section: Discussionmentioning

confidence: 99%

“…Some researchers use the objective structured assessment of technical skill (OSATS) scale developed by Martin et al in 1995, which includes seven items for evaluating surgeons' basic skills: respect for tissue, time and motion, instrument handling, knowledge of instrument, use of assistants, flow of operation and forward planning, and knowledge of the specific procedure 2) . Recently, Fecso et al also reported that surgery with a higher score is related to a lower incidence of postoperative complications in laparoscopic gastrectomy (LG) for gastric cancer 3) .…”

Section: Introductionmentioning

confidence: 99%

Surgical manipulation related to the risk of postoperative complications in laparoscopic gastrectomy: A study protocol

Honda

Hori

Kobayashi

et al. 2020

Ann. Cancer Res. Therap.

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Background: Few researches have reported the relationship between surgical skill and outcome on gastric cancer surgery. To prevent complication after gastrectomy, we need to identify specific manipulation or techniques that can increase the risk. In the present report, we attempt to identify techniques that directly cause intra-abdominal infectious complications (IAICs). Methods: This is a study protocol. We planned the multicenter case-control study, where the cases are patients who developed IAICs and the controls were those who did not develop IAICs after gastrectomy. All of one-hundred patients diagnosed as clinical ≤T4a and ≤N1, and underwent distal gastrectomy are extracted. Two raters blinded to the outcome evaluate each video after editing to remove personal information from the operating videos. We then identified items with significant difference between the two groups for consideration of whether or not they were risk factors for IAIC.

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“…Uyguladığınız tekniğin onkolojik açıdan yeterliliğini ve güvenilirliğini gösteren parametrelerden birisi de diseke edilen lenf nodu sayısıdır. Litaratürdeki serilerde ortalama çıkarılan lenf nodu sayısına bakıldığında total gastrektomi grubu için ortalama 18-47 (min-max) distal gastrektomi grubu için ortalama 9-33 (min-max) arasında verilmektedir 12,26,29,38 . Bizim serimizde çıkarılan lenf nodu total gastrektomi grubu için 16-53 (min-max), distal gastrektomi grubu için 23-43 (minmax) arasında ve literartür ile uyumlu olarak bulundu.…”

Section: Gereç Ve Yöntemunclassified

“…Literatürdeki serilerde postoperatif 30 günlük mortalite total gastrektomi grubunda %0-8,2 distal gastrektomi grubunda %0-7 olarak verilmiştir ve açık teknik gastrektomiye göre daha düşüktür. 25,26,29,30,42 Bizim çalışmamızda hiçbir hasta da postoperatif mortalite gelişmedi.…”

Section: Gereç Ve Yöntemunclassified

Early results in laparoscopic gastric cancer surgery

Yalav

Topal

Ünal

et al. 2019

Cukurova Medical Journal

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The aim of this study was to evaluate the early results of laparoscopic gastrectomy performed in a university clinic. Materials and Methods: Laparoscopic gastrectomy performed between September 2015 and September 2018 were divided into two groups as total and distal, and evaluated in terms of the technical, pathological and early postoperative complications. Results: Eighteen patients (11 male and 7 female) were included in the study. The mean age was 57.4 and the mean BMI was 26.3. Surgical treatment was prioritised in 13 patients and only five patients underwent neoadjuvant treatment protocols. Total gastrectomy was the preferred surgical method in 14 patients and distal gastrectomy in 4 patients. All patients underwent standard D2 lymph dissection according to tumor localization and 33.2 was the mean number of lymph nodes dissected in the total gastrectomy group; while a mean of 32 lymph nodes were dissected in the distal gastrectomy group. The mean oral start time was 6.4 days in the total gastrectomy group and 2.5 days in the distal gastrectomy group. Duodenal stump leak was detected in 4 patients, esophagojejunostomy leak was detected in 2 patients, while 1 patient had bleeding in the drain location. Conclusion: There are many studies demonstrating the adequacy of laparoscopic gastrectomy and lymphatic dissection. However, we believe that as the experience increases in these surgeries with many technical difficulties and a long learning duration; the operation time will be shortened and the complication rate will decrease. Amaç: Bu çalışmada bir üniversite kliniğinde gerçekleştirilen laparoskopik gastrektomilerin erken dönem sonuçlarının paylaşılması amaçlanmıştır. Gereç ve Yöntem: Eylül 2015-Eylül 2018 tarihleri arasında yapılan laparoskopik gastrektomiler total ve distal olmak üzere iki gruba ayrılmış, teknik, patolojik sonuç ve erken postoperatif komplikasyonlar açısından incelenmiştir. Bulgular: Çalışmaya 11'i erkek, 7'si kadın olmak üzere 18 hasta dahil edilmiştir. Yaş ortalaması 57,4 olup, ortalama BMI 26,3 idi. 13 hastada cerrahi ilk planda tutulmuş sadece beş hastaya neoadjuvan tedavi protokolü uygulanmıştır. Total gastrektomi 14 hastada, distal gastrektomi 4 hastada tercih edilen ameliyat yöntemidir. Tüm hastalara tümör yerleşimine göre standart D2 lenf disseksiyonu uygulandı ve Total gastrektomi grubunda Ortalama 33,2 distal gastrektomi grubunda 32 lenf nodu disseke edildi. Ortalama oral başlama süresi ve Total gastrektomi grubunda 6,4 gün distal gastrektomi grubunda 2,5 gün idi. Duodenal güdük kaçağı 4 hastada, özefagojejunostomi kaçağı 2 hastada tespit edilirken 1 hastada da dren yerinde kanama görüldü. Sonuç: Laparoskopik gastrektomi ve lenfatik disseksiyonun yeterliliğini gösteren birçok çalışma bulunmaktadır. Ancak öğrenim süreci uzun, teknik zorlukları fazla olan bu ameliyatlarda deneyim ve tecrübe arttıkça ameliyat sürenin kısalacağını ve komplikasyon oranının azalacağını düşünmekteyiz.

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Technical Performance as a Predictor of Clinical Outcomes in Laparoscopic Gastric Cancer Surgery

Cited by 59 publications

References 39 publications

Assessment of 3-Dimensional vs 2-Dimensional Imaging and Technical Performance Using a Multiport Intraoperative Data Capture and Analytic System for Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass Surgery

Assessment of 3-Dimensional vs 2-Dimensional Imaging and Technical Performance Using a Multiport Intraoperative Data Capture and Analytic System for Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass Surgery

Surgical manipulation related to the risk of postoperative complications in laparoscopic gastrectomy: A study protocol

Early results in laparoscopic gastric cancer surgery

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