AIM:To investigate the proficiency level reached in laparoscopic splenectomy using the learning curve method.METHODS:All patients in need of splenectomy for benign causes in whom laparoscopic splenectomy was attempted...AIM:To investigate the proficiency level reached in laparoscopic splenectomy using the learning curve method.METHODS:All patients in need of splenectomy for benign causes in whom laparoscopic splenectomy was attempted by a single surgeon during a time period of 6 years were included in the study (n=33). Besides demographics, operation-related variables and the response to surgery were recorded. The patients were allocated to groups of five, ranked according to the date of the operation. Operation duration, complications, postoperative length of stay, conversion to laparotomy and splenic weight were then compared between these groups.RESULTS: There was a significant difference regarding operation times between the groups (P = 0.001). An improvement was observed after the first 5 cases. The learning curve was flat up to the 25th case. Following the 25th case the operation times decreased still further. There was no difference between the groups regarding the other parameters.CONCLUSION: Unlike the widely accepted "L" shape, the learning curve for laparoscopic splenectomy is a horizontal lazy "S" with two distinct slopes. Privileges may be granted after the first 5 cases. However proficiency seems to require 25 cases.展开更多
Objective： McKeown esophagectomy followed by cervical and abdominal procedures has been commonly used for invasive esophageal carcinoma. This minimally-invasive operative procedure in the lateral prone position has b...Objective： McKeown esophagectomy followed by cervical and abdominal procedures has been commonly used for invasive esophageal carcinoma. This minimally-invasive operative procedure in the lateral prone position has been considered to be the most appropriate method. We describe our experiences in minimally invasive McKeown esophagectomy （MIME） for esophageal cancer. Methods： Between March 2016 and February 2018, a total of 82 patients underwent MIME by a single group in our department （a single center）. All procedure, operation, oncology, and complication data were reviewed. Results： All MIME procedures were completed successfully, with no conversions to open surgery. The median operative time was 260 min, and median blood loss was 100 ml. The average number of total harvested lymph nodes was 20.1 in the chest and 13.5 in the abdomen. There were no deaths within 30 postoperative days. Twenty cases （24.4%） developed postoperative complications, including anastomotic leak in 4 （4.9%）, single lateral recurrent nerve palsy in 4 （4.9%）, bilateral recurrent nerve palsy in 1 （1.2%）, pulmonary problems in 3 （3.7%）, chyle ~eak in 1 （1.2%）, and other complications in 7 （including pleural effusions in 4, incomplete ileus in 2, and neck incision infection in 1; 8.54%）. Average postoperative hospitalization time was 12 d. Blood loss, operation time, morbidity rate, and the number of harvested lymph nodes were analyzed by evaluating learning curves in different periods. Significant differences were found in operative time （P=-0.006）, postoperative hospitalization days （P=0.015）, total harvested lymph nodes （P=0.003）, harvested thoracic lymph nodes （P=0.006）, and harvested abdominal lymph nodes （P=0.022） among different periods. Conclusions： Surgical outcomes following MIME for esophageal cancer are safe and acceptable. The MIME procedure for stages I and II could be performed proficiently and reached an experience plateau after approximately 25 cases.展开更多
文摘AIM:To investigate the proficiency level reached in laparoscopic splenectomy using the learning curve method.METHODS:All patients in need of splenectomy for benign causes in whom laparoscopic splenectomy was attempted by a single surgeon during a time period of 6 years were included in the study (n=33). Besides demographics, operation-related variables and the response to surgery were recorded. The patients were allocated to groups of five, ranked according to the date of the operation. Operation duration, complications, postoperative length of stay, conversion to laparotomy and splenic weight were then compared between these groups.RESULTS: There was a significant difference regarding operation times between the groups (P = 0.001). An improvement was observed after the first 5 cases. The learning curve was flat up to the 25th case. Following the 25th case the operation times decreased still further. There was no difference between the groups regarding the other parameters.CONCLUSION: Unlike the widely accepted "L" shape, the learning curve for laparoscopic splenectomy is a horizontal lazy "S" with two distinct slopes. Privileges may be granted after the first 5 cases. However proficiency seems to require 25 cases.
基金Project supported by the Medical and Health Technology Development Program of Zhejiang Province(No.2015KYA130)the National Natural Science Foundation of China(No.31571446)
文摘Objective： McKeown esophagectomy followed by cervical and abdominal procedures has been commonly used for invasive esophageal carcinoma. This minimally-invasive operative procedure in the lateral prone position has been considered to be the most appropriate method. We describe our experiences in minimally invasive McKeown esophagectomy （MIME） for esophageal cancer. Methods： Between March 2016 and February 2018, a total of 82 patients underwent MIME by a single group in our department （a single center）. All procedure, operation, oncology, and complication data were reviewed. Results： All MIME procedures were completed successfully, with no conversions to open surgery. The median operative time was 260 min, and median blood loss was 100 ml. The average number of total harvested lymph nodes was 20.1 in the chest and 13.5 in the abdomen. There were no deaths within 30 postoperative days. Twenty cases （24.4%） developed postoperative complications, including anastomotic leak in 4 （4.9%）, single lateral recurrent nerve palsy in 4 （4.9%）, bilateral recurrent nerve palsy in 1 （1.2%）, pulmonary problems in 3 （3.7%）, chyle ~eak in 1 （1.2%）, and other complications in 7 （including pleural effusions in 4, incomplete ileus in 2, and neck incision infection in 1; 8.54%）. Average postoperative hospitalization time was 12 d. Blood loss, operation time, morbidity rate, and the number of harvested lymph nodes were analyzed by evaluating learning curves in different periods. Significant differences were found in operative time （P=-0.006）, postoperative hospitalization days （P=0.015）, total harvested lymph nodes （P=0.003）, harvested thoracic lymph nodes （P=0.006）, and harvested abdominal lymph nodes （P=0.022） among different periods. Conclusions： Surgical outcomes following MIME for esophageal cancer are safe and acceptable. The MIME procedure for stages I and II could be performed proficiently and reached an experience plateau after approximately 25 cases.
