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Wang B, Yu JF, Ao W, Wang J, Guo XY, Li MY, Huang WY, Zhou CP, Yan SY, Zhang LY, Wang SS, Cai SJ, Lin SY, Zhao WX. Optimizing robotic thyroid surgery: lessons learned from an retrospective analysis of 104 cases. Front Endocrinol (Lausanne) 2024; 15:1337322. [PMID: 38362277 PMCID: PMC10867960 DOI: 10.3389/fendo.2024.1337322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Background Robotic assistance in thyroidectomy is a developing field that promises enhanced surgical precision and improved patient outcomes. This study investigates the impact of the da Vinci Surgical System on operative efficiency, learning curve, and postoperative outcomes in thyroid surgery. Methods We conducted a retrospective cohort study of 104 patients who underwent robotic thyroidectomy between March 2018 and January 2022. We evaluated the learning curve using the Cumulative Sum (CUSUM) analysis and analyzed operative times, complication rates, and postoperative recovery metrics. Results The cohort had a mean age of 36 years, predominantly female (68.3%). The average body mass index (BMI) was within the normal range. A significant reduction in operative times was observed as the series progressed, with no permanent hypoparathyroidism or recurrent laryngeal nerve injuries reported. The learning curve plateaued after the 37th case. Postoperative recovery was consistent, with no significant difference in hospital stay duration. Complications were minimal, with a noted decrease in transient vocal cord palsy as experience with the robotic system increased. Conclusion Robotic thyroidectomy using the da Vinci system has demonstrated a significant improvement in operative efficiency without compromising safety. The learning curve is steep but manageable, and once overcome, it leads to improved surgical outcomes and high patient satisfaction. Further research with larger datasets and longer follow-up is necessary to establish the long-term benefits of robotic thyroidectomy.
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Affiliation(s)
- Bo Wang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
| | - Jia-Fan Yu
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
| | - Wei Ao
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
| | - Jun Wang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
| | - Xin-Yi Guo
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
| | - Meng-Yao Li
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
| | - Wen-Yu Huang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
| | - Chi-Peng Zhou
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
| | - Shou-Yi Yan
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
| | - Li-Yong Zhang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
| | - Si-Si Wang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
| | - Shao-Jun Cai
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
| | - Si-Ying Lin
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
| | - Wen-Xin Zhao
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China
- Clinical Research Center for Precision Management of Thyroid Cancer of Fujian Province, Fuzhou, China
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Stitz DJ, Guo AA, Lam PH, Murrell GAC. Determinants of Operative Time in Arthroscopic Rotator Cuff Repair. J Clin Med 2023; 12:jcm12051886. [PMID: 36902675 PMCID: PMC10003271 DOI: 10.3390/jcm12051886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
Arthroscopic rotator cuff repairs have been reported to take between 72 and 113 min to complete. This team has adopted its practice to reduce rotator cuff repair times. We aimed to determine (1) what factors reduced operative time, and (2) whether arthroscopic rotator cuff repairs could be performed in under 5 min. Consecutive rotator cuff repairs were filmed with the intent of capturing a <5-min repair. A retrospective analysis of prospectively collected data of 2232 patients who underwent primary arthroscopic rotator cuff repair by a single surgeon was performed using Spearman's correlations and multiple linear regression. Cohen's f2 values were calculated to quantify effect size. Video footage of a 4-min arthroscopic repair was captured on the 4th case. Backwards stepwise multivariate linear regression found that an undersurface repair technique (f2 = 0.08, p < 0.001), fewer surgical anchors (f2 = 0.06, p < 0.001), more recent case number (f2 = 0.01, p < 0.001), smaller tear size (f2 = 0.01, p < 0.001), increased assistant case number (f2 = 0.01, p < 0.001), female sex (f2 = 0.004, p < 0.001), higher repair quality ranking (f2 = 0.006, p < 0.001) and private hospital (f2 = 0.005, p < 0.001) were independently associated with a faster operative time. Use of the undersurface repair technique, reduced anchor number, smaller tear size, increased surgeon and assistant surgeon case number, performing repairs in a private hospital and female sex independently lowered operative time. A <5-min repair was captured.
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Affiliation(s)
- Daniel J. Stitz
- Orthopaedic Research Institute, St. George Hospital Campus, Kogarah, NSW 2217, Australia
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Allen A. Guo
- Orthopaedic Research Institute, St. George Hospital Campus, Kogarah, NSW 2217, Australia
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Patrick H. Lam
- Orthopaedic Research Institute, St. George Hospital Campus, Kogarah, NSW 2217, Australia
| | - George A. C. Murrell
- Orthopaedic Research Institute, St. George Hospital Campus, Kogarah, NSW 2217, Australia
- Correspondence: ; Tel.: +61-(02)-9113-2827
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Chen XP, Cochran A, Harzman AE, Ellison EC. A Novel Operative Coaching Program for General Surgery Chief Residents Improves Operative Efficiency. J Surg Educ 2021; 78:1097-1102. [PMID: 33358340 PMCID: PMC8217072 DOI: 10.1016/j.jsurg.2020.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/29/2020] [Accepted: 12/05/2020] [Indexed: 06/01/2023]
Abstract
INTRODUCTION We evaluated the effect of an operative coaching (OC) model on general surgery chief residents' operative efficiency (OE) measured by operative times. We hypothesized that higher levels of entrustment surgeons intend to offer resident in future similar cases are associated with improved OE. MATERIALS AND METHODS From July 2018 to June 2019, we used a validated instrument to score prospective resident entrustment in 228 evaluations of 6 chief residents during 12 OC sessions each (3 lap colectomy, 3 lap cholecystectomy, 3 ventral hernia, 3 inguinal hernia). Operative times of matched case CPT codes performed by coached chiefs (N = 500) were matched via CPT code to the cases of uncoached chiefs in the academic year 2016-2017 (N = 478). Statistical analysis was performed using Pearson correlation and one-way ANOVA. RESULTS Prospective entrustment scores from coached chief residents were associated with significantly shorter operative times in matched complex cases (CC) (r = -0.58, p = 0.0047). A similar trend was observed in noncomplex cases (NCC) (r = -0.29, p = 0.18). Compared to the historical cohort, coached chief residents showed a decrease in mean operative time during complex cases (p = 0.0008, d = 0.44), but an increase in mean operative times for noncomplex cases (p < 0.0001, d = 0.33). CONCLUSIONS An OC model improves chief residents' prospective entrustment leading to increased OE in cases with greater levels of operative complexity, showing a decrease in mean operative time compared to uncoached residents in certain procedures. This is the first report showing formal coaching may be a method to enhance chief resident OE.
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Affiliation(s)
| | - Amalia Cochran
- Department of Surgery, The Ohio State University, Columbus Ohio
| | - Alan E Harzman
- Department of Surgery, The Ohio State University, Columbus Ohio
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Bowe CM, Gurney B, Sloane J, Newlands C. Process mapping and Lean principles applied to orthognathic surgery. Br J Oral Maxillofac Surg 2020; 59:157-162. [PMID: 33441283 DOI: 10.1016/j.bjoms.2020.07.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 10/22/2022]
Abstract
Process mapping in industry is a well-established tool to improve efficiency. It is defined as a quality improvement technique that breaks down a process, or task, into its individual components, or steps, then analyses it. Lean principles are used to reduce waste and produce consistently good outcomes. Improving the operative efficiency of orthognathic surgery has many benefits. There is increasing demand for this complex surgery, and patients have appropriately high expectations with relation to their outcome. There are also increasing pressures for hospitals to reduce costs. In a recent paper by our group (Bowe et al, in press), we have published operating times for orthognathic procedures that are significantly shorter than in previously available series, with an average time for a bimaxillary osteotomy of 2 hours and 19 mins. Through observation of the senior authors' uniform technique, refined from experience of over 2,000 cases, a bimaxillary osteotomy was broken down into individual steps, all arranged in a process-mapped template with which to increase efficiency and results. We show here the multiple small operative efficiencies we have developed, and the Lean surgical principles which we use. This has enabled us to reduce the operative time of these common procedures, without compromising outcomes. This study presents an approach to process map bimaxillary orthognathic operations and shows how the application of Lean principles improves operative efficiency, and produces consistent results.
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Affiliation(s)
- C M Bowe
- Department of Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, Surrey, UK.
| | - B Gurney
- Department of Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, Surrey, UK
| | - J Sloane
- Department of Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, Surrey, UK
| | - C Newlands
- Department of Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, Surrey, UK
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DeMare AM, Luehmann NC, Kawak S, Abbott EE, Long J, Akay B, Brahmamdam P, Iacco AA, Novotny NM. Cost-Effective Approach to the Laparoscopic Appendectomy : Balancing Disposable Instrument Cost With Operative Time. Am Surg 2020; 86:715-720. [PMID: 32683956 DOI: 10.1177/0003134820923337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surgeons can help reduce health care spending by selecting affordable and efficient instruments. The laparoscopic appendectomy (LA) is commonly performed and can serve as a model for improving health care cost. METHODS We retrospectively reviewed all adult patients who underwent LA for non-perforated appendicitis from March 2015 to November 2017. Our objective was to determine which combination of disposable instruments afforded the lowest total operative cost without compromising postoperative outcomes. RESULTS In total, 1857 consecutive patients were reviewed from 2 hospitals. After determining the 8 most commonly utilized combinations of disposable instruments, 846 patients were ultimately analyzed. The combination of a LigaSure, Endoloop, and an EndoBag (LEB) had the shortest median operative time (25 minutes, P < .001) and lowest median total operative cost ($1893, P < .001). CONCLUSIONS The LEB instrument combination rendered the shortest operative time, lowest total operative cost, and can be used to maximize surgical value during LA.
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Affiliation(s)
| | | | - Samer Kawak
- 7005 Department of Surgery, Beaumont Health, Royal Oak, MI, USA
| | - Emily E Abbott
- 7005 Department of Surgery, Beaumont Health, Royal Oak, MI, USA
| | - Jordan Long
- 7005 Department of Surgery, Beaumont Health, Royal Oak, MI, USA
| | - Begum Akay
- 7005 Section of Pediatric Surgery, Beaumont Children's Hospital, Royal Oak, MI, USA.,Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Pavan Brahmamdam
- 7005 Section of Pediatric Surgery, Beaumont Children's Hospital, Royal Oak, MI, USA.,Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Anthony A Iacco
- 7005 Department of Surgery, Beaumont Health, Royal Oak, MI, USA.,Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Nathan M Novotny
- 7005 Section of Pediatric Surgery, Beaumont Children's Hospital, Royal Oak, MI, USA.,Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.,Department of Pediatric Surgery, Monroe Carell, Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN, USA
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Maruthappu M, Duclos A, Zhou CD, Lipsitz SR, Wright J, Orgill D, Carty MJ. The impact of team familiarity and surgical experience on operative efficiency: a retrospective analysis. J R Soc Med 2016; 109:147-53. [PMID: 27053357 DOI: 10.1177/0141076816634317] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The independent impact of individual surgical experience and team familiarity on surgical performance has been widely studied; however, the interplay of these factors and their relative, quantified, contributions to performance is poorly understood. We determined the impact of team familiarity and surgeon, and cumulative team experience on operative efficiency in total knee replacement. DESIGN Retrospective analysis of all total knee replacements conducted at the host institution in 1996-2009. Multivariate generalised-estimating-equation regression models were used to adjust for patient risk and clustering. SETTING Tertiary care academic hospital. PARTICIPANTS All patients undergoing TKR at the host institution in 1996-2009. MAIN OUTCOME MEASURE Operative efficiency. RESULTS A total of 4276 total knee replacements were completed by 1163 different surgical teams. The median experience level was 17.6 years for consultant surgeons and 3.7 years for trainee surgeons. After patient-risk adjustment, consultant surgical experience (p < 0.0001), trainee surgical experience (p < 0.05), cumulative team operative experience (p < 0.0001) and team familiarity (p < 0.0001) were associated with significant reductions in operative time. Surgical experience and team familiarity demonstrated concave and linear relationships with operative time, respectively. For a consultant surgeon, the expected reduction in operative time after 25 years in practice was 51 min, compared to a 21-min reduction over the span of 40 collaborations with the same team members. CONCLUSIONS Surgical experience and team familiarity display important and distinct relationships with operative time in total knee replacement. Appreciation of this interplay may serve to guide implementation and allocation of procedure-specific quality improvement strategies in surgery.
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