scholarly journals The Well-Tempered Clinic: The Clinical and Educational Importance of Cardiovascular Surgical Clinics (With a nod to Johann Sebastian Bach)

2020 ◽  
Vol 23 (5) ◽  
pp. E712-E717
Author(s):  
Curt Tribble
Keyword(s):  
Learning Curve ◽  
Johann Sebastian Bach ◽  
Surgical Patients ◽  
Independent Practice ◽  
Educational Value ◽  
Steep Learning Curve ◽  
Surgical Trainees ◽  
Educational Importance ◽  
Made In

A common assertion regarding the trajectory of surgeons from training to independent practice is that the first five years after completing training encompass the steepest learning curve of a young surgeon’s career. That assertion is often made in the context of beginning to perform operations independently.  However, it is likely that an under-recognized but equally steep learning curve will occur as newly minted surgeons begin to run their own clinics. In fact, it is likely that there is no aspect of surgical training with a greater discrepancy between the educational value for and the interest by surgical trainees than preoperative, postoperative, and follow-up clinics for surgical patients.

scholarly journals Laparoscopic pectopexy: the learning curve and comparison with laparoscopic sacrocolpopexy

2021 ◽  
Author(s):  
Fei Chi Chuang ◽  
Yu Min Chou ◽  
Ling Ying Wu ◽  
Tsai Hwa Yang ◽  
Wen Hsin Chen ◽  
...  
Keyword(s):  
Learning Curve ◽  
Operation Time ◽  
Synthetic Mesh ◽  
Laparoscopic Sacrocolpopexy ◽  
Apical Prolapse ◽  
Steep Learning Curve ◽  
Surgical Method ◽  
Surgical Field ◽  
Uncontrolled Bleeding

Abstract Introduction and hypothesis In addition to laparoscopic sacrocolpopexy (LS), laparoscopic pectopexy (LP) is a novel surgical method for correcting apical prolapse. The descended cervix or vaginal vault is suspended with a synthetic mesh by fixing the bilateral mesh ends to the pectineal ligaments. This study was aimed at developing a learning curve for LP and to compare it with results with LS. Methods We started laparoscopic/robotic pectopexy in our department in August 2019. This retrospective study included the initial 18 consecutive women with apical prolapse receiving LP and another group undergoing LS (21 cases) performed by the same surgeon. The medical and video records were reviewed. Results The age was older in the LP group than in the LS group (65.2 vs 53.1 years). The operation time of LP group was significantly shorter than that of the LS group (182.9 ± 27.2 vs 256.2 ± 45.5 min, p < 0.001). The turning point of the LP learning curve was observed at the 12th case. No major complications such as bladder, ureteral, bowel injury or uncontrolled bleeding occurred in either group. Postoperative low back pain and defecation symptoms occurred exclusively in the LS group. During the follow-up period (mean 7.2 months in LP, 16.2 months in LS), none of the cases had recurrent apical prolapse. Conclusions Laparoscopic pectopexy is a feasible surgical method for apical prolapse, with a shorter operation time and less postoperative discomfort than LS. LP may overcome the steep learning curve of LS because the surgical field of LP is limited to the anterior pelvis and avoids encountering the critical organs.

La crioablazione della prostata per adenocarcinoma

1995 ◽  
Vol 62 (4) ◽  
pp. 568-571
Author(s):  
F. Lugnani
Keyword(s):  
Learning Curve ◽  
Liquid Nitrogen ◽  
Steep Learning Curve ◽  
Homogeneous Groups ◽  
The Future ◽  
Long Term Follow Up

Physiopathological bases of cryosurgical damage are described: hypothermia, freezing, thawing are all disruptive moments causing necrosis. Last-generation cryosurgical apparatus allows the use of liquid nitrogen circulating through thin probes that are inserted percutaneously under u.s. guidance. Also thermosensors are used to monitor the procedure placing them in selected spots. 404 patients were treated in 3 different but homogeneous groups. Results of control biopsies were available at 3 months for 298 (15 pos.) and for 141 at 12 months (13 pos.). Cryoablation appears to be an interesting procedure, but its complexity requires accurate training with a steep “learning curve”; only long-term follow-up will test in the future its real efficacy.

Data Management in an Epidemiological Study : Experiences from the Iowa 500 Field Follow-up and Family Study

1980 ◽  
Vol 19 (01) ◽  
pp. 37-41
Author(s):  
R. F. Woolson ◽  
M. T. Tsuang ◽  
L. R. Urban
Keyword(s):  
Data Management ◽  
Epidemiological Study ◽  
Family Study ◽  
Data Sets ◽  
Data Handling ◽  
Management Decisions ◽  
Numerous Data ◽  
Made In

We are now conducting a forty-year follow-up and family study of 200 schizophrenics, 325 manic-depressives and 160 surgical controls. This study began in 1973 and has continued to the present date. Numerous data handling and data management decisions were made in the course of collecting the data for the project. In this report some of the practical difficulties in the data handling and computer management of such large and bulky data sets are enumerated.

scholarly journals 845 Flattening the Learning Curve: The Evaluation of Extended Laparoscopic Simulation Training for Novice Surgeons

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S A Joiya ◽  
M Hamid ◽  
Z Siddiqui
Keyword(s):  
Learning Curve ◽  
Skill Acquisition ◽  
Postoperative Recovery ◽  
Task Completion ◽  
Complication Rates ◽  
Novice Group ◽  
Surgical Trainees ◽  
Long Duration ◽  
Hospital Stays ◽  
Novice Surgeons

Abstract Introduction Associated with faster postoperative recovery, reduced length of hospital stays and scarring; laparoscopy has become the favoured approach for many surgical procedures across a range of specialties. However, due to its challenging learning curve, it has also been associated with increased theatre time and higher complication rates. Method A prospective, observational study with box trainers was carried out by novice medical students and trainees to evaluate the efficacy of long duration courses on skill acquisition. The novice group undertook a 5-week curriculum composed of lectures, demonstrations and spaced timed-assessments involving 3 tasks: hoop placement, stacking of sugar cubes and surgical cutting. Results Time taken for novice participants to complete a task individually and collectively improved markedly from the first to the third attempt, with an overall 44% reduction in time observed over the 5-weeks. We invited back 6 novice participants and 6 core surgical trainees after 4-weeks to complete the same tests. There was a further 18% time improvement in the novice group, with 44% faster task completion. Conclusions Given the success of this study and other simulation courses reported in the literature, we recommend more courses adopt a spaced-out approach; and a simulation curriculum for surgical trainees to cultivate greater skill acquisition.

scholarly journals The nasal cantilever technique in children undergoing primary cleft lip surgery: novel concepts and review

2020 ◽  
Vol 5 (1-2) ◽  
pp. 53-62
Author(s):  
Badr M. I. Abdulrauf
Keyword(s):  
Learning Curve ◽  
Cleft Lip ◽  
Nasal Bone ◽  
Case Series ◽  
Nasal Deformity ◽  
Challenging Issue ◽  
Primary Surgery ◽  
Novel Concept ◽  
Cleft Nasal Deformity

AbstractBackgroundNasal deformity associated with cleft lip deformity is a challenging issue, encompassing controversies, theories, and a diversity of techniques. Historically, esthetic outcomes have ranged from being below expectations to barely acceptable.MethodBased on the concept that the nasal cartilaginous framework in clefts is similar to that of a collapsing pyramid, a novel suspension technique has been described. The entire cartilaginous structure is lifted from the infratip segment with a loop suture and is secured in a cantilever fashion onto the periosteum overlying the nasal bone. This part of the operation is performed in a semiclosed manner. The technique is applied during primary surgery in bilateral and unilateral nasal cleft lip deformities, with changes in the orientation of the cantilever loop suture. Studies conducted by Masters S. Tajima, H. McComb, H. Thomson, D. Fisher, and J. Mulliken, which are most relevant to this article, have been reviewed and discussed throughout.ResultsThe technique was first applied over 10 years ago. A case series of nine children whose parents consented to the developing technique is presented with follow-up ranging from months to years, along with technical descriptions and illustrative drawings. None of these cases had preoperative orthopedic correction, molding, or postoperative nostril splints. The esthetic outcome was optimal enough; none of the cases requested a secondary correction.ConclusionThe nasal cantilever technique is a novel concept in cleft nasal deformity, which can be used in conjunction with an appropriate lip technique, per the surgeon’s discretion. Other than a learning curve, we believe that it provides a solid correction by securing the cartilaginous structures after they have been mobilized to a stable base, the nasion.

scholarly journals Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chunxiao Wang ◽  
Yao Zhang ◽  
Xiaojie Tang ◽  
Haifei Cao ◽  
Qinyong Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Operation Duration ◽  
The Mean

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

scholarly journals Open Versus Endoscopic Osteotomy of Posterosuperior Calcaneal Tuberosity for Haglund Syndrome: A Retrospective Cohort Study

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712110010
Author(s):  
Yanbin Pi ◽  
Yuelin Hu ◽  
Qinwei Guo ◽  
Dong Jiang ◽  
Xin Xie ◽  
...  
Keyword(s):  
Cohort Study ◽  
Learning Curve ◽  
Endoscopic Surgery ◽  
Extent Of Resection ◽  
Endoscopic Procedure ◽  
Postoperative Outcomes ◽  
Open Procedure ◽  
Surgery Group ◽  
Duration Of Surgery

Background: Although endoscopic calcaneoplasty and retrocalcaneal debridement have been extensively applied to treat Haglund syndrome, evidence of the value of the endoscopic procedure remains to be fully established. Purpose/Hypothesis: The purpose of this study was to compare the postoperative outcomes and the amount of osteotomy between open and endoscopic surgery for the treatment of Haglund syndrome. It was hypothesized that endoscopic calcaneoplasty would lead to higher patient satisfaction and lower complication rates compared with open surgical techniques. Study Design: Cohort study; Level of evidence, 3. Methods: The following postoperative outcomes were compared between the open surgery group (n = 20) and the endoscopic surgery group (n = 27): visual analog scale for pain, American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, Foot Function Index, Tegner score, Ankle Activity Score, and 36-Item Short Form Health Survey; postoperative complications; and duration of surgery. To determine the extent of resection, the authors compared the calcaneal height ratio, calcaneal resection ratio, calcaneal resection angle, pitch line, and Haglund deformity height between groups. The learning curve for endoscopic calcaneoplasty was also calculated. Results: There were no significant differences between the open and endoscopic groups on any outcome score. Two patients in the open group reported temporary paresthesia around the incisional site, indicating sural nerve injuries; no complication was reported in the endoscopy group. None of the parameters for extent of resection were statistically significant between the groups. The duration of surgery was 44.90 ± 10.52 and 65.39 ± 11.12 minutes in the open and endoscopy groups, respectively ( P = .001). Regarding the learning curve for endoscopic calcaneoplasty (6 surgeons; 27 follow-up patients; 9 patients lost to follow-up), the duration of surgery reached a steady point of 55.68 ± 4.19 minutes after the fourth operation. Conclusion: The results of this study indicated that the endoscopy procedure was as effective as the open procedure. The endoscopic procedure required significantly more time than the open procedure, and the duration of the endoscopic procedure was shortened only after the fourth operation, suggesting that it requires high technical skills and familiarity with the anatomic relationships.

ID: 3527213 THIRD SPACE ENDOSCOPY AFTER FORMAL ENDOSCOPY ADVANCED FELLOWSHIP TRAINING IN THE US: ONE YEAR LINEAR FOLLOW UP OF INDEPENDENT PRACTICE

2021 ◽  
Vol 93 (6) ◽  
pp. AB281
Author(s):  
Mohamed Abdelfatah Magdy ◽  
Ali M. Ahmed ◽  
Shajan Peter ◽  
Douglas R. Morgan ◽  
Qiang Cai
Keyword(s):  
Third Space ◽  
Fellowship Training ◽  
Independent Practice ◽  
The Us ◽  
One Year
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