Reduced-port robotic pancreaticoduodenectomy versus open pancreaticoduodenectomy: a single-surgeon experience

Surgery Today ◽  
2022 ◽  
Author(s):  
Cho-Han Chiang ◽  
Cho-Hsien Chiang ◽  
Teng-Chieh Cheng ◽  
Cho-Hung Chiang ◽  
Ching-Lung Hsieh ◽  
...  
Keyword(s):  
Surgeon Experience ◽  
Reduced Port ◽  
Robotic Pancreaticoduodenectomy ◽  
Open Pancreaticoduodenectomy

scholarly journals Kiguchi Method, A Novel Simplified Technique For Pancreaticojejunostomy In Minimally Invasive Pancreaticoduodenectomy, Significantly Reduces Postoperative Pancreatic Fistula Rate In Patients With A Soft Pancreatic Texture 

2020 ◽  
Author(s):  
Gozo Kiguchi ◽  
Atsushi Sugioka ◽  
Masaya Nakauchi ◽  
Masayuki Kojima ◽  
Akira Yasuda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Pancreatic Texture ◽  
Technical Issues ◽  
Fistula Rate ◽  
Robotic Pancreaticoduodenectomy ◽  
Open Pancreaticoduodenectomy

Abstract Background: Minimally invasive pancreaticoduodenectomy (MIPD), including laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), is especially demanding due to pancreaticojejunostomy (PJ). Postoperative pancreatic fistula (POPF) remains the most serious complication in MIPD as well as in open pancreaticoduodenectomy (OPD). Conventional PJ in MIPD did not improve the POPF rate and hospital stay, contrary to expectations. High POPF rates have been attributed to technical issues encountered during MIPD, including motion restriction and insufficient water tightness; therefore, we have developed the Kiguchi method as a novel PJ technique optimized for MIPD. Herein, we describe the technique and assess its impact in patients with a soft pancreatic texture, which has been reported to be significantly related to POPF.Methods: The retrospective study included 188 patients with a soft pancreatic texture. Briefly, 143 patients underwent OPD with conventional PJ (OPD group); 19 patients underwent MIPD with conventional PJ (Old-MIPD group), including 7 and 12 patients undergoing LPD and RPD, respectively; and 26 patients underwent MIPD using the Kiguchi method (New-MIPD group), including 15 and 11 patients undergoing LPD and RPD, respectively. Short-term outcomes were assessed, and POPF risk factors were determined using univariate and multivariate analyses.Results: The grade B/C POPF rate was significantly lower in the New-MIPD group than in the Old-MIPD and OPD groups (3.8% vs. 42.1% and 36.4%, respectively). The median hospital stay was significantly shorter in the New-MIPD group than in the Old-MIPD and OPD groups (23 vs. 33 and 31 days, respectively). By multivariate analysis, the PJ method and male sex were significant POPF risk factors. Among the patients without POPF, the hospital stay was significantly shorter in those undergoing MIPD than in those undergoing OPD, suggesting the advantage of MIPD. Conclusions: The novel Kiguchi method significantly reduced the POPF rate in patients with a soft pancreatic texture.

1275: Deterioration of Laparoscopic Surgical Performance with Alteration in Angles of Perspective: the Effect of Surgeon Experience

2004 ◽  
Vol 171 (4S) ◽  
pp. 336-336
Author(s):  
Allison Frisella ◽  
Caroline D Ames ◽  
David Lieber ◽  
Ramakrishna Venkatesh ◽  
Peter G. Schulam ◽  
...  
Keyword(s):  
Surgical Performance ◽  
Surgeon Experience

Endoscopic transsphenoidal surgery for Cushing's disease; a single surgeon experience

2019 ◽  
Author(s):  
Aoife Garrahy ◽  
Zarina Brady ◽  
Mark Sherlock ◽  
Christopher J Thompson ◽  
Amar Agha ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Cushing's Disease ◽  
Endoscopic Transsphenoidal Surgery ◽  
Surgeon Experience

The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve

2020 ◽  
Vol 32 (2) ◽  
pp. 207-220 ◽  
Author(s):  
Darryl Lau ◽  
Vedat Deviren ◽  
Christopher P. Ames
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Surgical Complication ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Years Of Experience ◽  
Surgeon Experience ◽  
Operative Measures

OBJECTIVEPosterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD.METHODSA retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss.RESULTSA total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss.CONCLUSIONSSurgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon’s experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.

scholarly journals Cost analysis of laparoscopic versus open pancreaticoduodenectomy for periampullary malignancy

HPB ◽  
2017 ◽  
Vol 19 ◽  
pp. S76
Author(s):  
M. Gerber ◽  
D. Delitto ◽  
C. Crippen ◽  
T. George ◽  
G. Sarosi ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Open Pancreaticoduodenectomy

Time to event analysis for post-hypospadias repair complications: a single-surgeon experience

2021 ◽  
Author(s):  
Jin K. Kim ◽  
Mitchell Shiff ◽  
Michael E. Chua ◽  
Fadi Zu’bi ◽  
Jessica M. Ming ◽  
...  
Keyword(s):  
Event Analysis ◽  
Hypospadias Repair ◽  
Time To Event ◽  
Surgeon Experience

Dual trocar laparoscopy improves reduced-port surgery of the distal pancreas

2021 ◽  
pp. 1-7
Author(s):  
Christof Mittermair ◽  
Michael Weiss ◽  
Jan Schirnhofer ◽  
Eberhard Brunner ◽  
Christian Obrist ◽  
...  
Keyword(s):  
Reduced Port Surgery ◽  
Distal Pancreas ◽  
Reduced Port

674 Machine Learning and Automation in Burn Care: A Systematic Review

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S193-S193
Author(s):  
Samantha Huang ◽  
Justin Dang ◽  
Clifford C Sheckter ◽  
Haig A Yenikomshian ◽  
Justin Gillenwater
Keyword(s):  
Machine Learning ◽  
Systematic Review ◽  
Total Body Surface Area ◽  
Burn Wound ◽  
Burn Care ◽  
Surgeon Experience ◽  
Automated Software ◽  
Burn Depth ◽  
Automated Methods ◽  
Equal Weighting

Abstract Introduction Current methods of burn evaluation and treatment are subjective and dependent on surgeon experience, with high rates of inter-rater variability leading to inaccurate diagnoses and treatment. Machine learning (ML) and automated methods are being used to develop more objective and accurate methods for burn diagnosis and triage. Defined as a subfield of artificial intelligence that applies algorithms capable of knowledge acquisition, machine learning draws patterns from data, which it can then apply to clinically relevant tasks. This technology has the potential to improve burn management by quantitating diagnoses, improving diagnostic accuracy, and increasing access to burn care. The aim of this systematic review is to summarize the literature regarding machine learning and automated methods for burn wound evaluation and treatment. Methods A systematic review of articles available on PubMed and MEDLINE (OVID) was performed. Keywords used in the search process included burns, machine learning, deep learning, burn classification technology, and mobile applications. Reviews, case reports, and opinion papers were excluded. Data were extracted on study design, study objectives, study models, devices used to capture data, machine learning, or automated software used, expertise level and number of evaluators, and ML accuracy of burn wound evaluation. Results The search identified 592 unique titles. After screening, 35 relevant articles were identified for systematic review. Nine studies used machine learning and automated software to estimate percent total body surface area (%TBSA) burned, 4 calculated fluid requirements, 18 estimated burn depth, 5 estimated need for surgery, 6 predicted mortality, and 2 evaluated scarring in burn patients. Devices used to estimate %TBSA burned showed an accuracy comparable to or better than traditional methods. Burn depth estimation sensitivities resulted in unweighted means &gt;81%, which increased to &gt;83% with equal weighting applied. Mortality prediction sensitivity had an unweighted mean of 96.75%, which increased to 99.35% with equal weighting. Conclusions Machine learning and automated technology are promising tools that provide objective and accurate measures of evaluating burn wounds. Existing methods address the key steps in burn care management; however, existing data reporting on their robustness remain in the early stages. Further resources should be dedicated to leveraging this technology to improve outcomes in burn care.

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