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Vijayakumar A, Abdel-Rasoul M, Hekmat R, Merritt RE, D'Souza DM, Jackson GP, Kneuertz PJ. National learning curves among robotic thoracic surgeons in the United States: Quantifying the impact of procedural experience on efficiency and productivity gains. J Thorac Cardiovasc Surg 2024; 167:869-879.e2. [PMID: 37562675 DOI: 10.1016/j.jtcvs.2023.07.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/12/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE This study aims to characterize the aggregate learning curves of US surgeons for robotic thoracic procedures and to quantify the impact on productivity. METHODS National average console times relative to cumulative case number were extracted from the My Intuitive application (Version 1.7.0). Intuitive da Vinci robotic system data for 56,668 lung resections performed by 870 individual surgeons between 2021 and 2022 were reviewed. Console time and hourly productivity (work relative value units/hour) were analyzed using linear regression models. RESULTS Average console times improved for all robotic procedures with cumulative case experience (P = .003). Segmentectomy and thymectomy had the steepest initial learning curves with a 33% and 34% reduction of the average console time for proficient (51-100 cases) relative to novice surgeons (1-10 cases), respectively. The hourly productivity increase for proficient surgeons ranged from 11.4 work relative value units/hour (+26%) for lobectomy to 17.0 work relative value units/hour (+50%) for segmentectomy. At the expert level (101+ cases), average console times continued to decrease significantly for esophagectomy (-18%) and lobectomy (-23%), but only minimally for wedge resections (-1%) (P = .003). The work relative value units/hour increase at the expert level reached 50% for lobectomy and 40% for esophagectomy. Surgeon experience level, dual console use, system model, and robotic stapler use were factors independently associated with console time for robotic lobectomy. CONCLUSIONS The aggregate learning curve for robotic thoracic surgeons in the United States varies significantly by procedure type and demonstrate continued improvements in efficiency beyond 100 cases for lobectomy and esophagectomy. Improvements in efficiency with growing experiences translate to substantial productivity gains.
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Affiliation(s)
- Ammu Vijayakumar
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | - Robert E Merritt
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Desmond M D'Souza
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Gretchen P Jackson
- Digital, Intuitive Surgical, Sunnyvale, Calif; Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Peter J Kneuertz
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Girelli L, Bertolaccini L, Casiraghi M, Petrella F, Galetta D, Mazzella A, Donghi S, Lo Iacono G, Cara A, Guarize J, Spaggiari L. Anastomosis Complications after Bronchoplasty: Incidence, Risk Factors, and Treatment Options Reported by a Referral Cancer Center. Curr Oncol 2023; 30:10437-10449. [PMID: 38132394 PMCID: PMC10742568 DOI: 10.3390/curroncol30120760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Sleeve lobectomy with bronchoplasty is a safe surgical technique for the management of lung cancer and endobronchial localization of extrapulmonary cancers. However, anastomotic complications can occur, and treatment strategies are not standardized. METHODS Data from 280 patients subjected to bronchoplasty were retrospectively analyzed, focusing on surgical techniques, anastomotic complications, and their management. Multivariate analysis was performed, and Kaplan-Meier curves were used to determine survival. RESULTS Ninety percent of 280 surgeries were for lung cancer. Anastomotic complications occurred in 6.42% of patients: late stenosis in 3.92% and broncho-pleural fistula in 1.78%. The median survival was 65.90 months (95% CI = 41.76-90.97), with no difference (p = 0.375) for patients with (51.28 months) or without (71.03 months) anastomotic complications. Mortality at 30 days was higher with anastomotic complications (16.7% vs. 3%, p = 0.014). Multivariable analysis confirmed pathological stage (N+) as a risk factor for anastomotic complications (p = 0.016). Our mortality (3.93%) and morbidity rate (41.78%) corresponded to recent series results. CONCLUSIONS In our experience, surgery is preferred to avoid life-threatening complications in bronchopleural fistulas. Bronchoscopic balloon dilatation is preferred for benign strictures. The nodal stage is related to complications (p = 0.0014), reflecting the aggressiveness of surgery, which requires extended radical lymphadenectomy.
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Affiliation(s)
- Lara Girelli
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Monica Casiraghi
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20141 Milan, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20141 Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20141 Milan, Italy
| | - Antonio Mazzella
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Stefano Donghi
- Interventional Pneumology Unit, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (S.D.); (J.G.)
| | - Giorgio Lo Iacono
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Andrea Cara
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
| | - Juliana Guarize
- Interventional Pneumology Unit, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (S.D.); (J.G.)
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.B.); (D.G.); (A.M.); (G.L.I.); (A.C.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20141 Milan, Italy
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