The learning curve on uniportal video-assisted thoracic surgery: An analysis of proficiency

Vieira, Arthur; Bourdages-Pageau, Etienne; Kennedy, Kevin F.; Ugalde, Paula A.

doi:10.1016/j.jtcvs.2019.11.006

Cited by 32 publications

(39 citation statements)

References 22 publications

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“…At present, thoracoscopic minimally invasive surgery is the main method of thoracic surgery [1,2]. In recent years, single-port video-assisted thoracoscopic (SPVAT) surgery has been widely used in thoracic surgery [3,4], especially in lung wedge resection [5]. SPVAT lung wedge resection has the advantages of less incision, less pain and faster recovery.…”

Section: Introductionmentioning

confidence: 99%

Effect of Single-Injection Thoracic Paravertebral Block via the Intrathoracic Approach for Analgesia After Single-Port Video-Assisted Thoracoscopic Lung Wedge Resection: A Randomized Controlled Trial

Tian

et al. 2021

Pain Ther

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Introduction: Pain is still severe after singleport video-assisted thoracoscopic (SPVAT) lung wedge resection. We observed the effect of single-injection thoracic paravertebral block (TPB) via the intrathoracic approach for analgesia after SPVAT lung wedge resection. Methods: Sixty patients undergoing SPVAT lung wedge resection were randomly divided into a control group and an observation group. All patients underwent TPB via the intrathoracic approach at the T4 level with a scalp needle before closing the chest. The patients in the observation group received 20 ml 0.375% ropivacaine at the T4 level, and the patients in the control group received 20 ml of 0.9% saline. A patient-controlled intravenous analgesic (PCIA) pump with sufentanil was attached to all patients after surgery. The sufentanil consumption and number of PCIA presses in the first 24 h after surgery were recorded. The visual analogue scale (VAS) scores (during rest and coughing) were recorded at 6 h, 12 h, 24 h, and 36 h after surgery. The incidence of adverse reactions after surgery were recorded. Results: The sufentanil consumption in the observation group was significantly lower than that in the control group (34.2 ± 1.9 lg vs. 52.3 ± 2.3 lg; P \ 0.001). The VAS score at 6, 12, and 24 h after surgery, the incidence of adverse reactions after surgery in the observation group were significantly lower than those in the control group (all P \ 0.05). The number of PCIA presses in the observation group was significantly lower than that in the control group [0 (0-0) times vs. 3 (2-4) times, P \ 0.001]. Conclusions: Single-injection TPB via the intrathoracic approach under thoracoscopic direct vision is easy to perform and can effectively alleviate postoperative pain after SPVAT lung wedge resection, with fewer adverse reactions. Trial Registration: ChiCTR2000034726.

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Section: Introductionmentioning

confidence: 99%

Effect of Single-Injection Thoracic Paravertebral Block via the Intrathoracic Approach for Analgesia After Single-Port Video-Assisted Thoracoscopic Lung Wedge Resection: A Randomized Controlled Trial

Tian

et al. 2021

Pain Ther

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“…Besides, their CUSUM were plotted based on the performance score (either success or failure) rather than operative time. Operative time, or the speed of operation is an useful parameter to determine CUSUM [8,12,13], including oocyte retrieval procedures [14]. In the current study, the CUSUM was determined based on the change trend of operative time, a more appropriate parameter to de ne the learning phases.…”

Section: Discussionmentioning

confidence: 99%

Defining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive CenterDefining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive Center

Cao

You

et al. 2020

Preprint

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Objective: The objective of this study was to determine the novice trainee’s learning curve for oocytes retrieval procedure through assessment of oocytes retrieval efficiency, operative time and other operative characteristics. Methods: This retrospective cohort study included 200 consecutive patients undergoing transvaginal ultrasound guided oocytes retrieval procedure. Those patients underwent oocyte retrieval procedure by a single operator and one experienced supervisor. Their clinical data, including demographic data, ovarian stimulation cycle information, surgical procedure, and laboratory data were collected over 3 months. CUSUM analyses based on the operative time were performed to determine the learning curve. Results: The mean operative time was 10.10 min. Based on the CUSUM plot of operative time, the learning curve can be divided into three separated phases, phase 1 (case 1 to case 49) was learning phase, phase 2 (case 50 to case 130) was acquisition phase, and phase 3 (case 131 to case 200) was proficiency phase. The operative time was significantly shortened from phase 1 to phase 3 (phase 1, 13.37 ± 4.83min; phase 2, 10.21 ± 3.30 min; phase 3, 7.67 ± 3.24 min, P < 0.001). The oocyte retrieval efficiency was also notably improved from phase 1 to phase 3 (78.2% to 100% based on method 1 to determine oocyte retrieval efficiency, and 104.2% to 121.1% based on method 2 to determine oocyte retrieval efficiency). The retrieved oocytes number, the fertilization rate, clinical pregnancy rate among the three phases showed no significant differences. No patients had severe adverse events. As determined by multiple linear regression, learning phase is the only independent predictor of oocyte retrieval efficiency. Conclusion: Trainees practice transvaginal ultrasound guided oocytes retrieval are expected to achieve a stabilized procedure over consecutive training cases, with acquisition of the skills at 49 cases, and proficiency at 130 cases. Cumulative operative experience can improve the operative time and oocytes retrieval efficiency, but showed minimal influence on retrieved oocytes number and reproductive outcomes.

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“…In the revised papers we noticed that most of the authors studied their LC by dividing the patients who underwent a VATS lobectomy according to the chronological sequence of surgery. Vieira and Liu describe, for example, 3 phases: respectively these were the initial (first 60 lobectomies), the transitional [61-140] and the proficient phase for the first author and the ascending (first 30 lobectomies), the plateau and the descending phase [61-120] for the second one (11,12). With the same statistical division, Divisi and Zhao report their LC of VATS by dividing their lobectomies into 3 uniform groups based on their initial or late experience (13,14).…”

Section: The Lc Of Vats Lobectomymentioning

confidence: 99%

“…One last tip that we believe important to report is Vieira's advice: perioperative and post-surgical outcomes should be recorded and audited regularly to allow adjustments during different learning phases. The author found that by watching systematically the video recordings of the surgeries one could understand which steps could be improved (11).…”

Section: The Lc Of Vats Lobectomymentioning

confidence: 99%

Review of the learning curve of video-assisted thoracic surgery & robotic-assisted thoracic surgery lobectomies—similarities and differences

Paladini¹,

Meniconi²,

Ghisalberti³

et al. 2021

Curr Chall Thorac Surg

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Video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) are two different types of surgical approach for the treatment of early stage lung cancer. Technological innovations brought on the beginning of a new era in thoracic surgery in the last 20-30 years. A need for training led many thoracic surgery centers to study how the learning of these new techniques took place among their surgeons: the so-called learning curve (LC). This review aimed not only to evaluate the recent literature about the LC of these two minimally invasive techniques but also to point out what are the similarities and differences between the two techniques. We chose a total of 50 reports from papers published between 2008 and 2019: 30 about the LC of VATS lobectomy and 20 studies about the LC of RATS lobectomy. We observed a substantial overlap between the training of both techniques even though the LC of RATS appears to be shorter than VATS. There are common cornerstones in the two LCs like reduction of operating times, reduction of blood loss, more complete lymphadenectomy, conversion rate reduction; a minimum number of at least 50 cases for VATS and 20 cases for RATS are needed to overcome the initial phase of the LC. We noticed that the need for accessory thoracoscopic access is particularly reduced with experience in the LC of the single-port VATS while the evaluation of the docking time is uniquely taken into account for RATS as for the need of specific training for basic robotic skills.

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The learning curve on uniportal video-assisted thoracic surgery: An analysis of proficiency

Cited by 32 publications

References 22 publications

Effect of Single-Injection Thoracic Paravertebral Block via the Intrathoracic Approach for Analgesia After Single-Port Video-Assisted Thoracoscopic Lung Wedge Resection: A Randomized Controlled Trial

Effect of Single-Injection Thoracic Paravertebral Block via the Intrathoracic Approach for Analgesia After Single-Port Video-Assisted Thoracoscopic Lung Wedge Resection: A Randomized Controlled Trial

Defining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive CenterDefining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive Center

Review of the learning curve of video-assisted thoracic surgery & robotic-assisted thoracic surgery lobectomies—similarities and differences

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