3D image system improves the learning curve and contributes to medical education of rhinoplasty

Background: Rhinoplasty is a complex surgical procedure that requires critical analysis and precise design before surgery, making it a challenging operation for both the surgical team and medical educators. This study aimed to evaluate the impact of 3D design involvement on learning curves and to establish a more effective method for rhinoplasty education.Methods: Surgeons who participated in an educational program were divided into two groups. The experimental group was involved in the 3D design before the operation, and the control group was asked to review the rhinoplasty atlas. A self-assessment questionnaire was used to evaluate the learning curve of the eight rhinoplasty procedures for each surgeon, and the overall satisfaction rate data were also collected.Results: The self-assessment scores in both groups showed an increasing trend from the first to the eighth operation. The mean scores of the experimental group were significantly higher than those of the control group at the fifth operation(P=0.01). The satisfaction rate of the experimental group(91.7%) was higher than that of the control group(54.5%).Conclusion: The 3D imaging system can improve the learning curve and satisfaction rate of rhinoplasty education,proving that it is an easy and effective tool for medical education.

Current Status and Perspectives of External Versus Internal Pancreatic Duct Drainage during the Learning Curve of Laparoscopic Pancreaticoduodenectomy

Objectives: To summarize the current status and outlook of pancreatic duct drainage in the learning curve period of laparoscopic pancreaticoduodenectomy (LPD). Methods: By searching the literature related to the efficacy analysis of internal versus external pancreatic duct drainage in pancreaticoduodenectomy (OPD) and the learning curve period of laparoscopic pancreaticoduodenectomy in recent years at home and abroad and making a review. Results: Because of the complexity of the LPD surgical procedure, the high technical requirements and the high complication rate, it is necessary for the operator and his/her team to carry out a certain number of cases to pass through the learning curve in order to have a basic mastery of the procedure. In recent years, more and more pancreatic surgeons have begun to promote and use pancreatic duct drains. However, no consensus conclusion has been reached on whether to choose internal or external drainage for pancreatic duct placement and drainage in LPD. Conclusions: Intraoperative application of pancreatic duct drainage reduces the incidence of pancreatic fistula during the learning curve of laparoscopic pancreaticoduodenectomy. However, external pancreatic duct drainage and internal pancreatic duct drainage have both advantages and disadvantages, so when choosing the drainage method, one should choose the appropriate drainage method in conjunction with one’s own conditions, so as to reduce the incidence of complications.

A Novel Mixed Precision Distributed TPU GAN for Accelerated Learning Curve

Deep neural networks are gaining importance and popularity in applications and services.Due to the enormous number of learnable parameters and datasets,the training of neural networks is computationally costly.Parallel and distributed computation-based strategies are used to accelerate this training process.Generative Adversarial Networks(GAN)are a recent technological achievement in deep learning.These generative models are computationally expensive because a GAN consists of two neural networks and trains on enormous datasets.Typically,a GAN is trained on a single server.Conventional deep learning accelerator designs are challenged by the unique properties of GAN,like the enormous computation stages with non-traditional convolution layers.This work addresses the issue of distributing GANs so that they can train on datasets distributed over many TPUs(Tensor Processing Unit).Distributed learning training accelerates the learning process and decreases computation time.In this paper,the Generative Adversarial Network is accelerated using the distributed multi-core TPU in distributed data-parallel synchronous model.For adequate acceleration of the GAN network,the data parallel SGD(Stochastic Gradient Descent)model is implemented in multi-core TPU using distributed TensorFlow with mixed precision,bfloat16,and XLA(Accelerated Linear Algebra).The study was conducted on the MNIST dataset for varying batch sizes from 64 to 512 for 30 epochs in distributed SGD in TPU v3 with 128×128 systolic array.An extensive batch technique is implemented in bfloat16 to decrease the storage cost and speed up floating-point computations.The accelerated learning curve for the generator and discriminator network is obtained.The training time was reduced by 79%by varying the batch size from 64 to 512 in multi-core TPU.

Deep Learning-Based ECG Classification for Arterial Fibrillation Detection

The application of deep learning techniques in the medical field,specifically for Atrial Fibrillation(AFib)detection through Electrocardiogram(ECG)signals,has witnessed significant interest.Accurate and timely diagnosis increases the patient’s chances of recovery.However,issues like overfitting and inconsistent accuracy across datasets remain challenges.In a quest to address these challenges,a study presents two prominent deep learning architectures,ResNet-50 and DenseNet-121,to evaluate their effectiveness in AFib detection.The aim was to create a robust detection mechanism that consistently performs well.Metrics such as loss,accuracy,precision,sensitivity,and Area Under the Curve(AUC)were utilized for evaluation.The findings revealed that ResNet-50 surpassed DenseNet-121 in all evaluated categories.It demonstrated lower loss rate 0.0315 and 0.0305 superior accuracy of 98.77%and 98.88%,precision of 98.78%and 98.89%and sensitivity of 98.76%and 98.86%for training and validation,hinting at its advanced capability for AFib detection.These insights offer a substantial contribution to the existing literature on deep learning applications for AFib detection from ECG signals.The comparative performance data assists future researchers in selecting suitable deep-learning architectures for AFib detection.Moreover,the outcomes of this study are anticipated to stimulate the development of more advanced and efficient ECG-based AFib detection methodologies,for more accurate and early detection of AFib,thereby fostering improved patient care and outcomes.

基于改进Q-learning算法移动机器人局部路径研究

针对局部路径规划时因无法提前获取环境信息导致移动机器人搜索不到合适的路径,以及在采用马尔可夫决策过程中传统强化学习算法应用于局部路径规划时存在着学习效率低下及收敛速度较慢等问题,提出一种改进的Q-learn-ing(QL)算法。首先设计一种动态自适应贪婪策略,用于平衡移动机器人对环境探索和利用之间的问题;其次根据A*算法思想设计启发式学习评估模型,从而动态调整学习因子并为搜索路径提供导向作用;最后引入三阶贝塞尔曲线规划对路径进行平滑处理。通过Pycharm平台仿真结果表明,使得改进后的QL算法所规划的路径长度、搜索效率及路径平滑性等特性上都优于传统Sarsa算法及QL算法,比传统Sarsa算法迭代次数提高32.3%,搜索时间缩短27.08%,比传统QL算法迭代次数提高27.32%,搜索时间缩短17.28%,路径规划的拐点大幅度减少,局部路径优化效果较为明显。

Outcome and costs of laparoscopic pancreaticoduodenectomy during the initial learning curve vs laparotomy

AIM:To compare laparoscopic pancreaticoduodenectomy(TLPD) during the initial learning curve with open pancreaticoduodenectomy in terms of outcome and costs.METHODS:This is a retrospective review of the consecutive patients who underwent TLPD between December 2009 and April 2014 at our institution.The experiences of the initial 15 consecutive TLPD cases,considered as the initial learning curve of each surgeon,were compared with the same number of consecutive laparotomy cases with the same spectrum of diseases in terms of outcome and costs.Laparoscopic patients with conversion to open surgery were excluded.Preoperative demographic and comorbidity data were obtained.Postoperative data on intestinal movement,pain score,mortality,complications,and costs were obtained for analysis.Complications related to surgery included pneumonia, intra-abdominal abscess,postpancreatectomy hemorrhage,biliary leak,pancreatic fistula,delayed gastric emptying,and multiple organ dysfunction syndrome.The total costs consisted of cost of surgery,anesthesia,and admission examination.RESULTS:A total of 60 patients,including 30 consecutive laparoscopic cases and 30 consecutive open cases,were enrolled for review.Demographic and comorbidity characteristics of the two groups were similar.TLPD required a significantly longer operative time(513.17 ± 56.13 min vs 371.67 ± 85.53 min,P < 0.001).The TLPD group had significantly fewer mean numbers of days until bowel sounds returned(2.03 ± 0.55 d vs 3.83 ± 0.59 d,P < 0.001) and exhaustion(4.17 ± 0.75 d vs 5.37 ± 0.81 d,P < 0.001).The mean visual analogue score on postoperative day 4 was less in the TLPD group(3.5 ± 9.7 vs 4.47 ± 1.11,P < 0.05).No differences in surgery-related morbidities and mortality were observed between the two groups.Patients in the TLPD group recovered more quickly and required a shorter hospital stay after surgery(9.97 ± 3.74 d vs 11.87 ± 4.72 d,P < 0.05).A significant difference in the total cost was found between the two groups(TLPD 81317.43 ± 2027.60 RMB vs laparotomy 78433.23 ± 5788.12 RMB,P < 0.05).TLPD had a statistically higher cost for both surgery(24732.13 ± 929.28 RMB vs 19317.53 ± 795.94 RMB,P < 0.001)and anesthesia(6192.37 ± 272.77 RMB vs 5184.10 ± 146.93 RMB,P < 0.001),but a reduced cost for admission examination(50392.93 ± 1761.22 RMB vs 53931.60 ± 5556.94 RMB,P < 0.05).CONCLUSION:TLPD is safe when performed by experienced pancreatobiliary surgeons during the initial learning curve,but has a higher cost than open pancreaticoduodenectomy.

Learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy

AIM: To investigate the learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy (SILC). METHODS: The clinical data of 180 consecutive transumbilical suture-suspension SILCs performed by a team in our department during the period from August 2009 to March 2011 were retrospectively analyzed. Patients were divided into nine groups according to operation dates, and each group included 20 patients operated on consecutively in each time period. The surgical outcome was assessed by comparing operation time, blood loss during operation, and complications between groups in order to evaluate the improvement in technique.RESULTS: A total of 180 SILCs were successfully performed by five doctors. The average operation time was 53.58 ± 30.08 min (range: 20.00-160.00 min) and average blood loss was 12.70 ± 11.60 mL (range: 0.00-100.00 mL). None of the patients were converted to laparotomy or multi-port laparoscopic cholecystectomy. There were no major complications such as hemorrhage or biliary system injury during surgery. Eight postoperative complications occurred mainly in the first three groups (n = 6), and included ecchymosis around the umbilical incision (n = 7) which resolved without special treatment, and one case of delayed bile leakage in group 8, which was treated by ultrasound-guided puncture and drainage. There were no differences in intraoperative blood loss, postoperative complications and length of postoperative hospital stay among the groups. Bonferroni's test showed that the operation time in group 1 was significantly longer than that in the other groups (F = 7.257, P = 0.000). The majority of patients in each group were discharged within 2 d, with an average postoperative hospital stay of 1.9 ± 1.2 d. CONCLUSION: Following scientific principles and standard procedures, a team experienced in multi-port laparoscopic cholecystectomy can master the technique of SILC after 20 cases.

Learning curve for hand-assisted laparoscopic D2 radical gastrectomy

AIM:To describe the learning curves of hand-assisted laparoscopic D2 radical gastrectomy(HALG) for the treatment of gastric cancer.METHODS:The HALG surgical procedure consists of three stages:surgery under direct vision via the port for hand assistance,hand-assisted laparoscopicsurgery,and gastrointestinal tract reconstruction.According to the order of the date of surgery,patients were divided into 6 groups(A-F) with 20 cases in each group.All surgeries were performed by the same group of surgeons.We performed a comprehensive and indepth retrospective comparative analysis of the clinical data of all patients,with the clinical data including general patient information and intraoperative and postoperative observation indicators.RESULTS:There were no differences in the basic information among the patient groups(P > 0.05).The operative time of the hand-assisted surgery stage in group A was 8-10 min longer than the other groups,with the difference being statistically significant(P = 0.01).There were no differences in total operative time between the groups(P = 0.30).Postoperative intestinal function recovery time in group A was longer than that of other groups(P = 0.02).Lengths of hospital stay and surgical quality indicators(such as intraoperative blood loss,numbers of detected lymph nodes,intraoperative side injury,postoperative complications,reoperation rate,and readmission rate 30 d after surgery) were not significantly different among the groups.CONCLUSION:HALG is a surgical procedure that can be easily mastered,with a learning curve closely related to the operative time of the hand-assisted laparoscopic surgery stage.

Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer

AIM: To evaluate the nature of the 'learning curve' for laparoscopy-assisted distal gastrectomy (LADG) with systemic lymphadenectomy for early gastric cancer. METHODS: The data of 90 consecutive patients with early gastric cancer who underwent LADG with systemic lymphadenectomy between April 2003 and November 2004 were reviewed. The 90 patients were divided into 9 sequential groups of 10 cases in each group and the average operative time of these 9 groups were determined. Other learning indicators, such as transfusion requirements, conversion rates to open surgery, postoperative complication, time to first flatus, and postoperative hospital stay, were evaluated. RESULTS: After the first 10 LADGs, the operative time reached its first plateau (230-240 min/operation) and then reached a second plateau (＜200 min/operation) for the final 30 cases. Although a significant improvement in the operative time was noted after the first 50 cases, there were no significant differences in transfusion requirements, conversion rates to open surgery, postoperative complications, time to first flatus, or postoperative hospital stay between the groups. CONCLUSION: Based on operative time analysis, this study show that experience of 50 cases of LADG with systemic lymphadenectomy for early gastric cancer is required to achieve optimum proficiency.

The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy： experience of a single surgeon with 500 cases in Taiwan, China

To analyze the learning curve for cancer control from an initial 250 cases （Group I） and subsequent 250 cases （Group II） of robotic-assisted laparoscopic radical prostatectomy （RALP） performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups, Positive surgical margin （PSM） and biochemical recurrence （BCR） were assessed as cancer control outcomes. Patients in Group II had significantly more advanced prostate cancer than those in Group I （22.2% vs 14.2%, respectively, with Gleason score 8-10, P = 0.033; 12.8% vs 5.6%, respectively, with clinical stage T3, P = 0.017）. The incidence of PSM in pT3 was decreased significantly from 49% in Group I to 32.6% in Group Ih A meaningful trend was noted for a decreasing PSM rate with each consecutive group of 50 cases, including pT3 and high-risk patients. Neurovascular bundle （NVB） preservation was significantly influenced by the PSM in high-risk patients （84.1% in the preservation group vs 43.9% in the nonpreservation group）. The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased significantly after 250 cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50 cases. NVB preservation during RALP for the high-risk group is not suggested due to increasing PSM.

Learning curve for double-balloon enteroscopy: Findings from an analysis of 282 procedures

AIM: To determine the learning curves for antegrade double-balloon enteroscopy (aDBE) and retrograde DBE (rDBE) by analyzing the technical success rates. METHODS: A retrospective analysis in a tertiary referral center. This study reviewed all cases from June 2006 to April 2011 with a target lesion in the small-bowel identified by either capsule endoscopy or computed tomography scan posted for DBE examinations. Main outcome measurements were: (1) Technical success of aDBE def ined by f inding or excluding a target lesion after achieving suff icient length of small bowel intubation; and (2) Technical success for rDBE was def ined by either f inding the target lesion or achieving stable overtube placement in the ileum. RESULTS: Two hundred and eighty two procedures fulf illed the inclusion criteria and were analyzed. These procedures were analyzed by blocks of 30 cases. Therewas no distinct learning curve for aDBE. Technical success rates for rDBE continued to rise over time, although on logistic regression analysis testing for trend, there was no signif icance (P = 0.09). The odds of success increased by a factor of 1.73 (95% CI: 0.93-3.22) for rDBE. For these data, it was estimated that at least 30-35 cases of rDBE under supervision were needed to achieve a good technical success of more than 75%. CONCLUSION: There was no learning curve for aDBE. Technical success continued to increase over time for rDBE, although a learning curve could not be proven statistically. Approximately 30-35 cases of rDBE will be required for stable overtube intubation in ileum.

Learning curve of enhanced recovery after surgery program in open colorectal surgery

BACKGROUND Enhanced recovery after surgery(ERAS) reduces hospitalization and complication following colorectal surgery. Whether the experience of multidisciplinary ERAS team affects patients' outcomes is unknown.AIM To evaluate and establish a learning curve of ERAS program for open colorectal surgery.METHODS This was a review of prospectively collected database of 380 "unselected"patients undergoing elective "open" colectomy and/or proctectomy under ERAS protocol from 2011(commencing ERAS application) to 2017 in a university hospital. Patients were divided into 5 chronological groups(76 cases per quintile). Surgical outcomes and ERAS compliance among quintiles were compared. Learning curves were calculated based on criteria of optimal recovery:defined as absence of major postoperative complications, discharge by postoperative day 5, and no 30-d readmission.RESULTS Hospitalization more than 5 d occurred in 22.6%(n = 86), major complication was present in 2.9%(n = 11) and 30-d readmission rate was 2.4%(n = 9) accounting for unsuccessful recovery of 25%(n = 95). Conversely, the overall rate of optimal recovery was 75%. The optimal recovery significantly increased from 57.9% in 1 st quintile to 72.4%-85.5% in the following quintiles(P < 0.001). Average compliance with ERAS protocol gradually increased over the time-from 68.6% in 1 st quintile to 75.5% in 5 th quintile(P < 0.001). The application of preoperative counseling,nutrition support, goal-directed fluid therapy, O-ring wound protector and scheduled mobilization significantly increased over the study period.CONCLUSION A number of 76 colorectal operations are required for a multidisciplinary team to achieve a significantly higher rate of optimal recovery and high compliance with ERAS program for open colorectal surgery.

Learning curves in minimally invasive esophagectomy

Surgical innovation and pioneering are important for improving patient outcome, but can be associated with learning curves. Although learning curves in surgery are a recognized problem, the impact of surgical learning curves is increasing, due to increasing complexity of innovative surgical procedures, the rapid rate at which new interventions are implemented and a decrease in relative effectiveness of new interventions compared to old interventions. For minimally invasive esophagectomy(MIE), there is now robust evidence that implementation can lead to significant learning associated morbidity(morbidity during a learning curve, that could have been avoided if patients were operated by surgeons that have completed the learning curve). This article provides an overview of the evidence of the impact of learning curves after implementation of MIE. In addition, caveats for implementation and available evidence regarding factors that are important for safe implementation and safe pioneering of MIE are discussed.

Cumulative sum analysis score and phacoemulsification competency learning curve

AIM： To use the cumulative sum analysis score（CUSUM） to construct objectively the learning curve of phacoemulsification competency.METHODS： Three second-year residents and an experienced consultant were monitored for a series of 70 phacoemulsification cases each and had their series analysed by CUSUM regarding posterior capsule rupture（PCR） and best-corrected visual acuity. The acceptable rate for PCR was 〈5%（lower limit h） and the unacceptable rate was 〉10%（upper limit h）. The acceptable rate for bestcorrected visual acuity worse than 20/40 was 〈10%（lower limit h） and the unacceptable rate was 〉20%（upper limit h）. The area between lower limit h and upper limit h is called the decision interval. RESULTS： There was no statistically significant difference in the mean age, sex or cataract grades between groups. The first trainee achieved PCR CUSUM competency at his 22 nd case. His best-corrected visual acuity CUSUM was in the decision interval from his third case and stayed there until the end, never reaching competency. The second trainee achieved PCR CUSUM competency at his 39^ th case. He could reach best-corrected visual acuity CUSUM competency at his 22 ^nd case. The third trainee achieved PCR CUSUM competency at his 41 st case. He reached bestcorrected visual acuity CUSUM competency at his 14 ^th case.CONCLUSION： The learning curve of competency in phacoemulsification is constructed by CUSUM and in average took 38 cases for each trainee to achieve it.

Learning curves of robot-assisted pedicle screw fixations based on the cumulative sum test

BACKGROUND In robot-assisted(RA)spine surgery,the relationship between the surgical outcome and the learning curve remains to be evaluated.AIM To analyze the learning curve of RA pedicle screw fixation(PSF)through fitting the operation time curve based on the cumulative summation method.METHODS RA PSFs that were initially completed by two surgeons at the Beijing Jishuitan Hospital from July 2016 to March 2019 were analyzed retrospectively.Based on the cumulative sum of the operation time,the learning curves of the two surgeons were drawn and fit to polynomial curves.The learning curve was divided into the early and late stages according to the shape of the fitted curve.The operation time and screw accuracy were compared between the stages.RESULTS The turning point of the learning curves from Surgeons A and B appeared in the 18th and 17th cases,respectively.The operation time[150(128,188)min vs 120(105,150)min,P=0.002]and the screw accuracy(87.50%vs 96.30%,P=0.026)of RA surgeries performed by Surgeon A were significantly improved after he completed 18 cases.In the case of Surgeon B,the operation time(177.35±28.18 min vs 150.00±34.64 min,P=0.024)was significantly reduced,and the screw accuracy(91.18%vs 96.15%,P=0.475)was slightly improved after the surgeon completed 17 RA surgeries.CONCLUSION After completing 17 to 18 cases of RA PSFs,surgeons can pass the learning phase of RA technology.The operation time is reduced afterward,and the screw accuracy shows a trend of improvement.

Adaptive Error Curve Learning Ensemble Model for Improving Energy Consumption Forecasting

Despite the advancement within the last decades in the field of smart grids,energy consumption forecasting utilizing the metrological features is still challenging.This paper proposes a genetic algorithm-based adaptive error curve learning ensemble(GA-ECLE)model.The proposed technique copes with the stochastic variations of improving energy consumption forecasting using a machine learning-based ensembled approach.A modified ensemble model based on a utilizing error of model as a feature is used to improve the forecast accuracy.This approach combines three models,namely CatBoost(CB),Gradient Boost(GB),and Multilayer Perceptron(MLP).The ensembled CB-GB-MLP model’s inner mechanism consists of generating a meta-data from Gradient Boosting and CatBoost models to compute the final predictions using the Multilayer Perceptron network.A genetic algorithm is used to obtain the optimal features to be used for the model.To prove the proposed model’s effectiveness,we have used a four-phase technique using Jeju island’s real energy consumption data.In the first phase,we have obtained the results by applying the CB-GB-MLP model.In the second phase,we have utilized a GA-ensembled model with optimal features.The third phase is for the comparison of the energy forecasting result with the proposed ECL-based model.The fourth stage is the final stage,where we have applied the GA-ECLE model.We obtained a mean absolute error of 3.05,and a root mean square error of 5.05.Extensive experimental results are provided,demonstrating the superiority of the proposed GA-ECLE model over traditional ensemble models.

Endoscopic transcanal myringoplasty:Is learning curve a myth?

Objective: To investigate the feasibility of transcanal endoscopic myringoplasty in the hand of young beginner surgeons who had just completed the residency programme.Methods: In a three year period(August 2012 to August 2015), 44 ears in 42 patients were operated upon by a beginner surgeon through the transcanal endoscopic approach in a subdistrict level hospital located in the north western ranges of the Himalayan region.Results: Of the 42 patient, 19 were male and 23 female. The mean age was 26.23 years(range: 15 e47 years). In 40 ears, complete perforation closure was achieved at six months(success rate: 90.9%). The mean air conduction PTA preoperatively was 40.84 dB HL and improved to 28.06 dB HL postoperatively(p <.001). The mean AB gap preoperatively was 22.40 dB, which improved to 9.1 dB postoperatively(p <.001).Conclusion: Endoscopic transcanal myringoplasty is safe and reliable even in young beginners' hands.Surgeons can consider endoscopic approach early in their careers without the fear of learning curve. The cost of endoscopic equipment is about one tenth as compared to open approach under a operating microscope, and an added advantage.

Does robot-assisted laparoscopic radical prostatectomy enable to obtain adequate oncological and functional outcomes during the learning curve?From the Korean experience

To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy(RALRP)during the learning curve,in terms of surgical,oncological and functional outcomes,we conducted a prospective survey on RALRP.From July 2007,a single surgeon performed 63 robotic prostatectomies using the same operative technique.Perioperative data,including pathological and early functional results of the patient,were collected prospectively and analyzed.Along with the accumulation of the cases,the total operative time,setup time,console time and blood loss were significantly decreased.No major complication was present in any patient.Transfusion was needed in six patients;all of them were within the initial 15 cases.The positive surgical margin rate was 9.8%(5/51)in pT2 disease.The most frequent location of positive margin in this stage was the lateral aspect(60%),but in pT3 disease multiple margins were the most frequent(41.7%).Overall,53(84.1%)patients had totally continent status and the median time to continence was 6.56 weeks.Among 17 patients who maintained preoperative sexual activity(Sexual Health Inventory for Men≥17),stage below pT2,followed up for>6 months with minimally one side of neurovascular bundle preservation procedure,12(70.6%)were capable of intercourse postoperatively,and the mean time for sexual intercourse after operation was 5.7 months.In this series,robotic prostatectomy was a feasible and reproducible technique,with a short learning curve and low perioperative complication rate.Even during the initial phase of the learning curve,satisfactory results were obtained with regard to functional and oncological outcome.

The Current State of Transradial Access:A Perspective on Transradial Outcomes,Learning Curves,and Same-Day Discharge

The adoption of transradial access in the United States and internationally has been growing over the past few years.In the population of patients presenting with acute coronary syndromes,particularly ST-elevation myocardial infarction,transradial access has the benefit of fewer vascular and bleeding complications and lower mortality rates over transfemoral access.We will examine the current evidence supporting transradial access for several patient populations,including those patients presenting with acute coronary syndromes.We will review the literature regarding the learning curve for transradial access with new operators,as well as experienced transfemoral operators new to transradial access.Finally,we will investigate the role of transradial access in same-day discharge for stable patients undergoing percutaneous coronary intervention.

Evaluation of the Single-Port Laparoscopic Right Hemicolectomy Learning Curve

Background: The use of single-port laparoscopy has gained popularity within recent years. Part of the appeal in learning this approach is that it draws heavily from concepts mastered through conventional laparoscopy. Various studies have shown the efficacy and feasibility of the single-port laparoscopic approach, but there are few that examine the learning curve in adopting this new technique. Objective: Our goal was to better define the learning curve in performing a single-port laparoscopic right hemicolectomy. Design: A review of prospectively gathered operative data was performed to analyze the results of single-port laparoscopic right hemicolectomies performed within our institution by experienced laparoscopic surgeons. The first 100 cases were divided into quintiles. Comparisons were made among the cohorts regarding patient demographics, operative time, length of stay, conversions, and complications. Results: There was no difference among quintiles with regard to age, sex, BMI, or ASA class. Operative time, conversions, length of stay, and number of complications did not significantly vary among each group of patients. There was a significant difference in estimated blood loss and length of stay between the fifth cohort and the others due to one patient’s poor outcome. Conclusions: The single-port laparoscopic right hemicolectomy learning curve for surgeons already skilled in laparoscopy is short. There are few differences in various outcome measures among groups at any stage in the learning curve. The skills utilized to perform conventional laparoscopic colorectal surgery readily translate to the single-port approach and result in proficiency from nearly the start.