Analysis of the surgical learning curve using the cumulative sum (CUSUM) method

2013 ◽  
Vol 32 (7) ◽  
pp. 964-967 ◽  
Author(s):  
Turlough Maguire ◽  
Christopher J. Mayne ◽  
Tim Terry ◽  
Douglas G. Tincello
Keyword(s):  
Learning Curve ◽  
Cumulative Sum ◽  
Cusum Method ◽  
Surgical Learning

scholarly journals The Surgical Learning Curve for Prostate Cancer Control After Radical Prostatectomy

2007 ◽  
Vol 99 (15) ◽  
pp. 1171-1177 ◽  
Author(s):  
A. J. Vickers ◽  
F. J. Bianco ◽  
A. M. Serio ◽  
J. A. Eastham ◽  
D. Schrag ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Learning Curve ◽  
Cancer Control ◽  
Surgical Learning

scholarly journals Evaluation of the learning curve for external cephalic version using cumulative sum analysis

2017 ◽  
Vol 60 (4) ◽  
pp. 343 ◽  
Author(s):  
So Yun Kim ◽  
Jung Yeol Han ◽  
Eun Hye Chang ◽  
Dong Wook Kwak ◽  
Hyun Kyung Ahn ◽  
...  
Keyword(s):  
Learning Curve ◽  
External Cephalic Version ◽  
Cumulative Sum ◽  
Cumulative Sum Analysis

scholarly journals Cumulative sum analysis of the learning curve for video-assisted minilaparotomy donor nephrectomy in healthy kidney donors

Medicine ◽  
2018 ◽  
Vol 97 (17) ◽  
pp. e0560 ◽  
Author(s):  
Jee Soo Park ◽  
Hyun Kyu Ahn ◽  
Joonchae Na ◽  
Hyung Ho Lee ◽  
Young Eun Yoon ◽  
...  
Keyword(s):  
Learning Curve ◽  
Donor Nephrectomy ◽  
Cumulative Sum ◽  
Kidney Donors ◽  
Video Assisted ◽  
Cumulative Sum Analysis

Evaluation of the learning curve for robot-assisted rectal surgery using the cumulative sum method

2022 ◽  
Author(s):  
Tetsuo Sugishita ◽  
Shunsuke Tsukamoto ◽  
Jun Imaizumi ◽  
Yasuyuki Takamizawa ◽  
Manabu Inoue ◽  
...  
Keyword(s):  
Learning Curve ◽  
Rectal Surgery ◽  
Robot Assisted ◽  
Cumulative Sum ◽  
Cumulative Sum Method

scholarly journals Subxiphoid uniportal video-assisted thoracoscopic pulmonary segmentectomy: effect of learning curve and future perspectives

2020 ◽  
Vol 58 (Supplement_1) ◽  
pp. i50-i57
Author(s):  
Amr Abdellateef ◽  
Xiaoyu Ma ◽  
Wenxiang Qiao ◽  
Zhigang Chen ◽  
Liang Wu ◽  
...  
Keyword(s):  
Learning Curve ◽  
Operative Time ◽  
Current Status ◽  
Case Group ◽  
Chest Drain ◽  
Cumulative Sum ◽  
Term Survival ◽  
Video Assisted ◽  
Cumulative Sum Analysis ◽  
Group 2

Abstract OBJECTIVES Subxiphoid uniportal video-assisted thoracoscopic segmentectomy (SU-VATs) has been widely adopted because it is associated with better postoperative pain scores. Nevertheless, it also has had some limitations that have gradually been decreasing. Therefore, our goal was to evaluate the change in perioperative results with SU-VATs as the learning curve developed to outline the current status and the points that should be of future concern. METHODS Three hundred patients who underwent SU-VATs from September 2014 to May 2018 were divided chronologically into 2 groups; group 1 comprised the first 150 cases and group 2 comprised the last 150 cases. Different perioperative variables were analysed and compared between the 2 groups. In addition, the cumulative sum analysis and multivariable logistic regression were conducted to identify the cut-off point and predictors of significant improvement in operative time. RESULTS The cumulative sum analysis showed significant improvement in the operative time after the 148th case. Group 2 showed a statistically significant decrease in operative time (104.3 ± 36.7 vs 132 ± 43.1 min; P < 0.001), amount of operative blood loss [50 (80 ml) vs 100 (50 ml); P < 0.001], chest drain duration (2.6 ± 1.6 vs 3.2 ± 1.4 days; P = 0.004) and hospital stay (3.7 ± 1.7 vs 4.2 ± 1.7 days; P = 0.008). The number of dissected lymph nodes was significantly higher in the second group [11 (4) vs 9 (4); P < 0.001]. CONCLUSIONS Limitations of SU-VATs are being overcome by the improvement in the learning curve and in the expertise of the surgeons. Our future concerns should focus on examining the long-term survival rate, the oncological efficacy and the effect on quality of life.

PS01.237: SAFETY OF RECURRENT LARYNGEAL NERVE NODAL DISSECTION IN PATIENTS WITH ESOPHAGEAL CANCER WHO HAD UNDERGONE CHEMORADIOTHERAPY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 117-117
Author(s):  
Yin-Kai Chao ◽  
Ivan De Leon Ayala
Keyword(s):  
Esophageal Cancer ◽  
Learning Curve ◽  
Recurrent Laryngeal Nerve ◽  
Conflicts Of Interest ◽  
Perioperative Complications ◽  
Group Versus ◽  
Laryngeal Nerve ◽  
The Us ◽  
Technical Challenges ◽  
Cusum Method

Abstract Background Lymph node dissection (LND) along the recurrent laryngeal nerve (RLN) is a challenging surgical procedure that carries a high risk of morbidity, especially in patients who had undergone chemoradiotherapy (CRT). Here, we retrospectively examined the feasibility and safety of thoracoscopic RLN LND in patients with esophageal cancer who had been previously treated with CRT. Methods Patients with esophageal cancer who had undergone thoracoscopic esophagectomy with RLN LND were divided into two groups according to prior treatment with CRT or not (CRT group versus upfront surgery [US] group, respectively). Intergroup comparisons were made in terms of 1) number of dissected nodes, 2) rates of RLN palsy, and 3) rates of perioperative complications. The learning curve for the RLN LND procedure was investigated with the cumulative sum (CUSUM) method. Results A total of 103 patients with esophageal cancer were included in the study (CRT group: n = 65; US group: n = 38). No conversion to open thoracotomy was required in either group. Moreover, intraoperative blood loss and the need for blood transfusions were similar. The technical challenges of RLN LND after CRT were more evident when performed in the left side. Accordingly, complete skeletonization of the left RLN was achieved only for 66.2% of patients in the CRT group, a percentage significantly lower than that obtained in the US group (86.8%; P = 0.022). Similarly, the rate of postoperative RLN palsy in the left side was significantly higher in the CRT group than in the US group (32.6% vs. 9.1%, respectively, P = 0.015), albeit not resulting in higher pneumonia rates. CUSUM analysis revealed a steep learning curve for left RLN LND performed in patients who had undergone CRT. Significant fluctuations in RLN palsy rates were observed over time, suggesting that proficiency did not improve linearly with increasing surgical experience. Conclusion To our knowledge, this is the first study to specifically investigate the feasibility and safety of thoracoscopic RLN LND in patients with esophageal cancer who had undergone CRT. Our data indicate that RLN LND is feasible even after CRT, although the technical challenges to be faced are greater than in CRT-naïve patients. Disclosure All authors have declared no conflicts of interest.

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