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2.
Urol Clin North Am ; 48(1): 113-125, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218586

RESUMO

Almost 30 years have passed since the inception of minimally invasive surgery in urology and specifically in pediatric urology. Laparoscopy has now become an essential tool in the pediatric urologic armamentarium. The application of robot-assisted surgery in pediatrics has allowed for widespread utilization for common reconstructive procedures such as pyeloplasty and ureteral reimplantation. Understanding the implementation, technical considerations, and outcomes are critical for continued success and adoption. This has allowed for increased use in more complex urologic procedures such as redo pyeloplasty, dismembered ureteral reimplantation, catheterizable channel creation, and bladder augmentation.


Assuntos
Pelve Renal/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Anestesia , Criança , Previsões , Humanos , Curva de Aprendizado , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/tendências , Reimplante , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/tendências , Obstrução Ureteral/cirurgia , Doenças Urológicas/congênito , Procedimentos Cirúrgicos Urológicos/tendências , Refluxo Vesicoureteral/cirurgia
3.
Urol Clin North Am ; 48(1): 51-70, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218594

RESUMO

Robotic-assisted radical cystectomy has gained increasing popularity over the past decade. Initially, the procedure was performed with extracorporeal urinary diversion given the technical challenges of the intracorporeal approach. Since then, innovative techniques have been described to facilitate bowel manipulation, assess ureteral and mesenteric vasculature, and perform ureteroenteric and urethro-ileal anastomosis. Overcoming the learning curve associated with intracorporeal urinary diversion can lead to decreased blood loss, shorter operative times, and faster convalescence, particularly with enhanced recovery protocols. Herein we review technical points, complications, outcomes, and future innovations in intracorporeal urinary diversion."


Assuntos
Cistectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Cistectomia/estatística & dados numéricos , Recuperação Pós-Cirúrgica Melhorada , Previsões , Humanos , Curva de Aprendizado , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Derivação Urinária/estatística & dados numéricos , Derivação Urinária/tendências
4.
Urologiia ; (6): 11-18, 2020 Dec.
Artigo em Russo | MEDLINE | ID: mdl-33377672

RESUMO

AIM: to analyze the learning curve of surgeons while performing laparoscopic partial nephrectomy in patients with localized renal parenchymal lesions by calculating the MIC (negative surgical margin, ischemia, and complications) index depending on tumor complexity according to the R.E.N.A.L. and PADUA nephrometric scores. MATERIALS AND METHODS: the retrospective study included the results of laparoscopic partial nephrectomies in 320 patients with localized renal parenchymal lesions. The procedures were carried out by four surgeons from the Institute of Urology and Human Reproductive Health of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia (EC-1; ESH-4; EB-7; ME-13) from January 2014 to June 2019. At baseline, all operators had experience of performing at least 30 laparoscopic interventions. In addition to the standard preoperative examination, a 3D virtual planning was carried out using the Amira 3D modeling program. In all cases, the nephrometric assessment of complexity was performed according to the R.E.N.A.L. and PADUA scores. The learning curve was assessed based on the results of operations based on the MIC index. All surgical interventions were divided into eras. In the era, 40 consecutive procedures for each operator were evaluated. Acquired skills were assessed over two eras. RESULTS: The average age of patients, of which 191 (59.7%) were men, was 54.4+/-11.37 years. The average body mass index was 28.55+/-3.85 kg/m2, the absolute volume of kidney lesions was 26.72+/-43.72 cm3, the average Charlson comorbidity index was 1.46+/-1.29, the average R.E.N.A.L. and PADUA scores were 6.38+/-1.75 and 7.92+/-1.51, respectively, the average duration of procedure was 150.36+/-50.18 min, the average blood loss was 227.94+/-280.22 ml, the average time thermal ischemia was 13.28+/-7.82 min. Postoperative complications were seen in 36 (11.2%) cases, of which grade III and more according to Clavien-Dindo developed in 8 patients (2.5%). A positive surgical margin was found in 4 (1.2%) patients. The overall MIC index was achieved in 243 (75.9%) cases; in era 1 it was seen in 71.9% cases in comparison with 80% in era 2. With the 1st degree of complexity (152 (47.5%) patients), MIC was achieved in 80.9% of cases, compared to 76.6% and 56.8% in patients with 2nd degree of complexity (n=124, 38.8%) and 3rd degree of complexity (n=44, 13.8%), respectively. Rate of MIC achievement in eras 1 and 2 for different surgeons were as following: 65% and 72.5%, 75 and 80%, 87.5 and 85% and 60 and 82.5%, for operator 1, 4, 7 and 13, respectively. Age, tumor complexity, R.E.N.A.L. score and PADUA score were the most significant parameters for determining MIC, identified on the basis of the criterion of equality of group means of discrete analysis. CONCLUSION: In all surgeons, the MIC index increased with the accumulation of experience in performing laparoscopic partial nephrectomy, but was lower with an increased degree of complexity of procedures. The minimum number of laparoscopic partial nephrectomies required to achieve an MIC more or equal 70% should be at least 40.


Assuntos
Neoplasias Renais , Laparoscopia , Adulto , Idoso , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Moscou , Nefrectomia , Estudos Retrospectivos , Federação Russa
5.
Respir Res ; 21(1): 320, 2020 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-33267892

RESUMO

BACKGROUND: The disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist's perception of its quality has not been evaluated. METHODS: To evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of central tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis. RESULTS: The most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 min. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 94.9% and the bronchoscopist was satisfied in 96.6% of the bronchoscopies. They highlighted the portability and immediacy of the aScope4TM to start the procedure in 99.3%, the possibility of taking and storing images in 99.3%. The CUSUM analysis showed average scores > 70/100 from the first procedure and from the 9th procedure more than 80% of the scores exceeded the 80/100 score. CONCLUSIONS: The aScope4™ scored well for ease of use, imaging, and aspiration. We found a learning curve with excellent scores from the 9th procedure. Bronchoscopists highlighted its portability, immediacy of use and the possibility of taking and storing images.


Assuntos
Atitude do Pessoal de Saúde , Broncoscópios , Broncoscopia/instrumentação , Equipamentos Descartáveis , Conhecimentos, Atitudes e Prática em Saúde , Pneumologistas , Competência Clínica , Estudos Transversais , Desenho de Equipamento , Pesquisas sobre Serviços de Saúde , Humanos , Curva de Aprendizado , Estudos Prospectivos , Espanha
6.
Arthroscopy ; 36(12): 3106-3107, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33276895

RESUMO

The learning curve of hip arthroscopy has been described as steep. A wide range, between 30 and 520 cases, has been gathered as the learning curve before complications are minimized. While the precise number of cases required for proficiency has remained elusive, the heterogeneity in surgeon profile and baseline training can serve as an explanation. Moreover, as caseload increases, case complexity, revision surgeries, and outside referrals may begin to consume the greater-volume surgeon. While the learning curve remains hard to define, innovations in surgical training hold the promise of improving proficiency. Regardless of career stage, hip arthroscopists can still expect improved patient outcomes with appropriate indications and a properly executed procedure.


Assuntos
Artroscopia , Cirurgiões , Articulação do Quadril/cirurgia , Humanos , Curva de Aprendizado , Duração da Cirurgia , Reoperação
7.
Khirurgiia (Mosk) ; (11): 48-52, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33210507

RESUMO

OBJECTIVE: To analyze assistants` influence on duration of surgery and learning period in minimally invasive video-assisted hemithyroidectomy. MATERIAL AND METHODS: The same surgeon performed 67 minimally invasive video-assisted hemithyroidectomies. Duration of surgery was analyzed in assistants with various number of interventions. Learning curves were designed using logarithmic function. RESULTS: Eight specialists with the same professional skill assisted to surgeon. Each of these specialists performed certain number of operations. Learning period made up 19, 26 and 44 procedures for mean numbers of assistances 21, 8 and 3, respectively. Duration of surgery in the group with 21 assistances was 63.96±2.94 min, for 3 assistances - 80.53±7.07 min in each of 6 assistants (z= -2.38; p<0.017). CONCLUSION: Constant surgeon`s assistants is a factor reducing surgery time. Higher number of operations with the same assistant has a reliable inverse correlation with surgery time and duration of learning period.


Assuntos
Curva de Aprendizado , Duração da Cirurgia , Tireoidectomia/métodos , Competência Clínica , Comportamento Cooperativo , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Cirurgiões/normas , Tireoidectomia/normas , Cirurgia Vídeoassistida/métodos
8.
PLoS One ; 15(11): e0242154, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33211728

RESUMO

Difficult airways can be managed with a range of devices, with video laryngoscopes (VLs) being the most common. The C-MAC® Video-Stylet (VS; Karl-Storz Germany), a hybrid between a flexible and a rigid intubation endoscope, has been recently introduced. The aim of this study is to investigate the performance of the VS compared to a VL (C-MAC Macintosh blade, Karl-Storz Germany) with regards to the learning curve for each device and its ability to manage a simulated difficult airway manikin. This is a single-center, prospective, randomized, crossover study involving twenty-one anesthesia residents performing intubations on a Bill 1™ (VBM, Germany) airway manikin model. After a standardized introduction, six randomized attempts with VL and VS were performed on the manikin. This was followed by intubation in a simulated difficult airway (cervical collar and inflated tongue) with both devices in a randomized fashion. The primary end-point of this study was the total time to intubation. All continuous variables were expressed as the median [interquartile range] and analyzed using the Mann-Whitney U test. A 2-way ANOVA with Bonferroni's post hoc test was used to compare both devices at each trial. All reported p values are two sided. The median total time to intubation on a simulated difficult airway was faster with the VS compared to VL (17 [13.5-25] sec vs 23 [18.5-26.5] sec, respectively; 95% CI; P = 0.031). Additionally, on a normal airway manikin, the VS has a comparable learning curve to the VL. In this manikin-based study, the novel VS was comparable to the VL in terms of learning curve in a normal airway. In a simulated difficult airway, the total time to intubation, though likely not clinically relevant, was faster with the VS to the VL. However, given the above findings, this study justifies further human clinical trials with the VS to see if similar benefits-faster time to intubation and similar learning curve to VL-are replicated clinically.


Assuntos
Anestesiologia/educação , Intubação Intratraqueal/instrumentação , Intubação/métodos , Laringoscopia/métodos , Curva de Aprendizado , Manequins , Anestesia , Vértebras Cervicais , Estudos Cross-Over , Glote/fisiologia , Humanos , Laringoscópios , Estudos Prospectivos , Língua , Gravação em Vídeo
9.
Urologiia ; (5): 28-32, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185342

RESUMO

PURPOSE: to determine the characteristics of the surgeon training curve in the development of percutaneous nephrolithotripsy (PN). MATERIALS AND METHODS: The first 125 PNs performed by one team of surgeons were investigated. In chronological order, five groups of 25 operations were formed. The assessment was carried out according to the following parameters: the duration of the operation; the number of perioperative complications; stone free rate (SFR). RESULTS: With the advanced training of the surgical team, the duration of the operation tended to decrease; after 50 PN the time decreased from 164+/-12 to 113+/-11 minutes. The duration of the next 50 PN conducted in the third and fourth groups remained unchanged - 105+/-10 and 103+/-12 minutes. In the fifth group, a decrease in time to 99+/-9 minutes had no significant differences with the third and fourth groups. The frequency of complications tended to decrease up to the 75th operation, followed by a plateau. The structure was dominated by complications related, according to the modified Clavien-Dindo classification, to Grade I and Grade II. With the accumulation of surgeons experience, there was a tendency towards an increase in SFR: in the 1st group - 72%, in 2 - 84%, in 3 and 4 - 88%, in 5 - 92% (p<0,05). CONCLUSIONS: in order to achieve the average indicators of the duration and effectiveness of PN, the surgical team must have experience of at least 50 such operations. Due to the long training process, it is advisable to use PN in organization with an estimated number of such operations of at least 30 per year.


Assuntos
Curva de Aprendizado , Litotripsia , Litotripsia/métodos
10.
Proc Natl Acad Sci U S A ; 117(47): 29381-29389, 2020 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-33229518

RESUMO

Humans have the fascinating ability to achieve goals in a complex and constantly changing world, still surpassing modern machine-learning algorithms in terms of flexibility and learning speed. It is generally accepted that a crucial factor for this ability is the use of abstract, hierarchical representations, which employ structure in the environment to guide learning and decision making. Nevertheless, how we create and use these hierarchical representations is poorly understood. This study presents evidence that human behavior can be characterized as hierarchical reinforcement learning (RL). We designed an experiment to test specific predictions of hierarchical RL using a series of subtasks in the realm of context-based learning and observed several behavioral markers of hierarchical RL, such as asymmetric switch costs between changes in higher-level versus lower-level features, faster learning in higher-valued compared to lower-valued contexts, and preference for higher-valued compared to lower-valued contexts. We replicated these results across three independent samples. We simulated three models-a classic RL, a hierarchical RL, and a hierarchical Bayesian model-and compared their behavior to human results. While the flat RL model captured some aspects of participants' sensitivity to outcome values, and the hierarchical Bayesian model captured some markers of transfer, only hierarchical RL accounted for all patterns observed in human behavior. This work shows that hierarchical RL, a biologically inspired and computationally simple algorithm, can capture human behavior in complex, hierarchical environments and opens the avenue for future research in this field.


Assuntos
Aprendizado de Máquina , Modelos Psicológicos , Reforço Psicológico , Adolescente , Adulto , Teorema de Bayes , Feminino , Humanos , Curva de Aprendizado , Masculino , Adulto Jovem
11.
Semin Vasc Surg ; 33(1-2): 16-23, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33218612

RESUMO

Both transfemoral carotid artery stenting (TF-CAS) and transcarotid artery revascularization (TCAR) are competing endovascular alternatives to carotid endarterectomy for the treatment of atherosclerotic carotid artery stenosis. TF-CAS is an endovascular procedure associated with a long learning curve and higher periprocedural stroke and death rates during an operator's early experience. Estimates suggest that more than 50 cases are required to achieve outcomes similar to carotid endarterectomy. TCAR is a novel hybrid procedure combining direct common carotid artery access and cerebral blood flow reversal with carotid stent placement. In distinction from TF-CAS, TCAR has a rather short learning curve. A multi-institutional analysis showed that operators achieved technical proficiency after approximately 10 to 15 cases. This was reinforced by a large Society for Vascular Surgery, Vascular Quality Initiative Transcarotid Artery Revascularization Surveillance Project analysis that demonstrated that expertise peaked after approximately 20 cases. Both studies found that TCAR was not associated with an increased rate of stroke or death during operator's early experience. These data suggest that TCAR is readily learned and patients are not at increased risk during a surgeon's early experience.


Assuntos
Angioplastia com Balão , Estenose das Carótidas/terapia , Cateterismo Periférico , Competência Clínica , Artéria Femoral , Curva de Aprendizado , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Cateterismo Periférico/efeitos adversos , Dispositivos de Proteção Embólica , Humanos , Punções , Fatores de Risco , Stents , Resultado do Tratamento
13.
Cir. pediátr ; 33(4): 166-171, oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195126

RESUMO

OBJETIVOS: Evaluar un programa de corrección toracoscópica de atresia de esófago comparándola con una cohorte histórica de pacientes. MATERIAL Y MÉTODOS: Estudio de cohortes retrospectivas. Grupo intervención: pacientes intervenidos por vía toracoscópica; grupo con-trol: pacientes con corrección abierta, con peso y edad gestacional en el mismo rango que la cohorte intervención. El peso mínimo para la cirugía toracoscópica fue de 1.700 g. Los efectos adversos se registraron mediante la clasificación de Clavien-Dindo. Se calculó la odds ratio del evento complicación. Una p < 0,05 se consideró estadísticamente significativa. RESULTADOS: Entre enero de 2006 y diciembre de 2019 se registraron 40 casos de atresia de esófago (tipo C de Gross). Diez pacientes se excluyeron del análisis, analizándose 12 pacientes en el grupo intervención y 18 en el grupo control. Los grupos fueron comparables respecto a sexo, edad gestacional y peso al nacimiento. En el grupo intervención el tiempo quirúrgico medio fue significativamente superior (146 min vs. 213 min; t test = -4,76; p = 0,0001) y se correlacionó con el número de caso (Rho de Spearman: -0,853; p = 0,0001).Dieciséis pacientes (52%) desarrollaron 19 complicaciones: 3 (16%) grado I, 8 (42%) grado II, 5 (26,5%) grado IIIa, 1 (5%) grado IIIb y 2 (10,5%) grado IVa, con una distribución similar entre grupos (Chi cua-drado:1,98; p = 0,73). La odds ratio para la presentación de un efecto adverso no mostró diferencias (OR: 2,4; IC 95%: 0,48-11,93; p = 0,44), incluso cuando se excluyeron los pacientes con complicación grado I aislada (OR: 1,4; IC 95%: 0,32-6,10; p = 0,72). Las complicaciones en el grupo intervención se concentraron en los primeros cinco casos. CONCLUSIONES: En el abordaje toracoscópico la morbilidad asociada a la curva de aprendizaje parece limitada al tiempo operatorio y a una tasa de complicaciones similar a la de la cirugía abierta


OBJECTIVES: To evaluate a thoracoscopic esophageal atresia repair program by comparing it with a historic patient cohort. MATERIALS AND METHODS: Retrospective cohort study. Surgery group: thoracoscopic surgery patients. CONTROL GROUP: open repair patients, with weight and gestational age in the same range as the surgery cohort. Minimal weight for thoracoscopic surgery was 1,700 g. Adverse effects were recorded using Clavien-Dindo classification. Complication odds ratio was calculated. Statistical significance was established at p < 0.05. RESULTS: From January 2006 to December of 2019, 40 cases of esophageal atresia (Gross type C) were recorded, 10 of which were excluded. The study consisted of 12 patients in the surgery group and 18 patients in the control group. Groups were similar in terms of sex, gestational age, and weight at birth. In the surgery group, mean operating time was significantly longer (146 min vs. 213 min.; T test = -4.76; p = 0.0001) and it was correlated with the case number (Spearman's Rho: -0.853; p = 0.0001).16 patients (52%) developed 19 complications: 3 (16%) grade I complications, 8 (42%) grade II complications, 5 (26.5%) grade IIIa complications, 1 (5%) grade IIIb complication, and 2 (10.5%) IVa complications, with a similar distribution between groups (Chi square: 1.98; p = 0.73). Odds ratio for adverse effect occurrence showed no differences (OR: 2.4; 95% CI: 0.48-11.93; p = 0.44) even when ex-cluding patients with isolated grade I complication (OR: 1.4; 95% CI: 0.32-6.10; p = 0.72). Complications in the surgery group occurred in the first 5 cases only. CONCLUSIONS: In the thoracoscopic approach, learning curve associ-ated morbidity seems limited to operating time and has a complication rate similar to that of open surgery


Assuntos
Humanos , Criança , Atresia Esofágica/cirurgia , Complicações Pós-Operatórias/classificação , Toracoscopia/métodos , Curva de Aprendizado , Índice de Gravidade de Doença , Estudos de Coortes , Atresia Esofágica/complicações , Estudos Retrospectivos , Razão de Chances , Fístula Traqueoesofágica/complicações , Fístula Traqueoesofágica/cirurgia , Idade Gestacional , Azul de Metileno/uso terapêutico , Anastomose Cirúrgica
14.
Surg Clin North Am ; 100(6): 1069-1078, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128880

RESUMO

Therapeutic endoscopy is an emerging field within general surgery. This article explores the evidence for and usage of endoscopic mucosal resection and endoscopic submucosal dissection throughout the gastrointestinal tract. We aim to educate surgeons and provide an understanding of these techniques. With education and appropriate training, the surgeon will gain confidence and hopefully adopt these tools into their daily practice.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Trato Gastrointestinal/cirurgia , Dissecação , Ressecção Endoscópica de Mucosa/educação , Ressecção Endoscópica de Mucosa/normas , Humanos , Curva de Aprendizado
15.
BMC Oral Health ; 20(1): 287, 2020 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-33076894

RESUMO

BACKGROUND: The spread of digital technology in dentistry poses new challenges and sets new goals for dentists. The aim of the present in vivo study was to determine the learning curve of intraoral scanning described by (1) scanning time and (2) image number (count of images created by intraoral scanner during the scanning process). METHODS: Ten dental students of Semmelweis University took part in the study. Dental students took digital study impressions using a 3Shape Trios 3® (3Shape, Copenhagen, Denmark) intraoral scanning device. Each student took 10 digital impressions on volunteers. Volunteer inclusion criteria included full dentition (except for missing third molars) and no prosthetic/restorative treatment. Digital impression taking was preceded by tuition consisting of both theoretical education and practical training. Digital impressions were taken of the upper and lower arches, and the bite was recorded according to the manufacturer's instructions. Total scanning times and image numbers were recorded. RESULTS: The difference in scanning time between the first and the tenth digital impressions was significant (p = 0.007). The average scanning time for the first impressions was 23 min 9 s; for the tenth impressions, it was 15 min 28 s. The difference between the scanning times of the first and the tenth procedures was 7 min 41 s. The average image count for the first impressions was 1964.5; for the tenth impressions, it was 1468.6. The image count difference between the first and the tenth procedures was 495.9. The image count versus sequential number of measurement curve shows an initial decreasing tendency followed by a trough around the sixth measurement and a final increasing phase. CONCLUSION: Our results indicate an association between the sequential number of measurements and the outcome variables. The drop in scanning time is probably explained by a practice effect of repeated use, i.e. the students learned to move the scanning tip faster. The image count first showed a decreasing tendency, and after the sixth measurement, it increased; there was no consistent decline in mean scan count. Shorter scanning times are associated with poorer coverage quality, with the operator needing to make corrections by adding extra images; this manifests as the time function of image counts taking an increase after the sixth measurement.


Assuntos
Técnica de Moldagem Odontológica , Curva de Aprendizado , Desenho Assistido por Computador , Modelos Dentários , Humanos , Imageamento Tridimensional , Projetos de Pesquisa
16.
J Urol ; 204(6): 1331-1332, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32969775
17.
J Urol ; 204(6): 1331, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32969776
19.
Medicine (Baltimore) ; 99(36): e22133, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899100

RESUMO

The importance of bedside assistants has been well established in various robotic procedures. However, the effect of assistants on the surgical outcomes of thyroid surgery remains unclear. We investigated the effects of a dedicated robot assistant (DRA) in robotic thyroidectomy. We also evaluated the learning curve of the DRA.Between January 2016 and December 2019, 191 patients underwent robotic total thyroidectomy, all of which were performed by a single surgeon. The DRA participated in 93 cases, while non-dedicated assistants (NRAs) helped with 98 cases. Demographic data, pathologic data, operative times, and postoperative complications were recorded and analyzed.Robotic thyroidectomy was successful in all 191 patients, and none required conversion to the conventional open procedure. Mean operative time was shorter in the DRA group than in the NRA group (183.2 ±â€Š33.6 minutes vs 203.1 ±â€Š37.9 minutes; P < .001). There were no significant differences in terms of sex distribution, age, preoperative serum thyroid stimulating hormone level, or pathologic characteristics between the groups. Cumulative summation analysis showed that it took 36 cases for the DRA to significantly reduce operative time. Mean operative time decreased significantly in the subgroup including the 37th to the 93rd DRA cases compared with the subgroup including only the first 36 DRA cases (199.7 ±â€Š37.3 minutes vs 172.8 ±â€Š26.4 minutes; P < .001). NRA group showed no definite decrease of operation time, which indicated that the NRAs did not significantly deviate from the mean performance.Increased experience of the bedside assistant reduced operative times in the robotic thyroidectomy. Assistant training should be considered as a component of robotic surgery training programs.


Assuntos
Internato e Residência/organização & administração , Procedimentos Cirúrgicos Robóticos/métodos , Tireoidectomia/métodos , Fatores Etários , Estudos de Casos e Controles , Feminino , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos
20.
Sci Rep ; 10(1): 15136, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32934256

RESUMO

The ASA score is known to be an independent predictor of complications and mortality following colorectal surgery. We evaluated early outcome in the initiation phase of a robotic oncological colorectal resection program in dependence of comorbidity and learning curve. 43 consecutive colorectal cancer patients (median age: 74 years) who underwent robotic surgery were firstly analysed defined by physical status (group A = ASA1 + 2; group B = ASA3). Secondly, outcome was evaluated relating to surgery date (group E: early phase; group L: late phase). There were no differences among groups A and B with regard to gender, BMI, skin-to-skin operative times (STS), N- and M-status, hospital-stay as well as overall rate of complications according to Dindo-Clavien and no one-year mortality. GroupA when compared to group B demonstrated significantly lower mean age (65.5 years ± 11.4 years vs 75.8 years ± 8.9 years), T-stage and ICU-stay. When separately analyzed for patients age ICU-stay was comparable (> 75 years vs. < 75 years). Group E and L demonstrated comparable characteristics and early outcome except more frequent lymphatic fistulas in group E. STS was reduced in group L compared to group E. Beyond learning curve aspects in our series, we could demonstrate that patient's physical condition according to ASA rather than age may have an impact on early outcome in the initial phase of a robotic oncological colorectal program.


Assuntos
Neoplasias Colorretais/mortalidade , Cirurgia Colorretal/mortalidade , Curva de Aprendizado , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Procedimentos Cirúrgicos Robóticos/mortalidade , Fatores Etários , Idoso , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
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