Abstract
BackgroundComputer-assisted jaw reconstruction (CAJR) has benefits in reducing operation time and improving reconstruction accuracy, compared to conventional freehand jaw reconstruction. However, no information is available regarding learning curves in CAJR with the use of 3D-printed patient-specific surgical plates (PSSP). The purpose of this study was to assess surgical outcomes and learning curve for the first 58 consecutive CAJR using 3D-printed PSSP performed by a single surgical team in a single institution.MethodsIn a prospective study, consecutive patients who underwent free flap CAJR using 3D-printed PSSP were included. The determination of proficiency, based on the cumulative sum of surgical success (no major adjustment of 3D-printed PSSP, flap survival) passing the acceptable boundary line of cumulative sum analysis, was the primary outcome. To find out any potential factors influencing the learning curve, baseline characteristics of patients were compared before and after proficiency achievement. Secondary outcomes included inflexion points of the total operation time, blood loss, length of hospital stay, and bone graft deviation, measured by the cumulative sum analysis.ResultsFrom December 2016 to November 2020, 58 consecutive cases underwent surgery performed by a single surgical team. The overall surgical success rate was 94.8% (55/58). A three-stage learning curve of primary outcome was observed. The proficiency was achieved after 23 cases. The proportions of advanced tumor staging and concomitant surgery after obtaining proficiency were significantly higher than those before achieving proficiency (p = 0.046 and p < 0.001, respectively). Mean values of operation time, intraoperative blood loss, length of hospital stay, and bone graft deviation were 532.5 ± 119.2 min, 1,006.8 ± 547.2 ml, 16.1 ± 6.3 days, and 0.9 ± 1.2 mm, respectively. Two trends of learning curve were observed in the CUSUM analyses of total operation time, length of hospital stay, and bone graft deviation, in which the first and second inflexion points occurred between 8 and 17 cases and between 43 and 46 cases, respectively.ConclusionOur results revealed a three-stage learning curve of CAJR with the use of PSSP, including initial learning, plateau, and overlearning. Based on CUSUM analysis, the surgical proficiency was achieved after 23 cases, and total operation time, length of hospital stay, and bone graft deviation stabilized after 8–17 cases.
Highlights
The emerging technique of computer-assisted jaw reconstruction (CAJR), which facilitates preoperative surgery simulation and transfers the virtual plan to a real operation, significantly impacted conventional surgical approaches [1, 2]
From December 2016 to November 2020, all consecutive patients who underwent CAJR with 3D-printed patient-specific surgical plates (PSSP) performed by a single surgical team led by the same chief surgeon in the Queen Mary Hospital in Hong Kong were enrolled without dropout
The other two cases were postoperative flap failures caused by venous compromise of flap at postoperative day 4 and late-stage artery thrombosis at postoperative day 10. 3D-printed PSSP were successfully used in all the patients
Summary
The emerging technique of computer-assisted jaw reconstruction (CAJR), which facilitates preoperative surgery simulation and transfers the virtual plan to a real operation, significantly impacted conventional surgical approaches [1, 2]. Studies have reported the benefits of CAJR compared to conventional freehand jaw reconstruction, including reductions of ischemia time, operation time, and related costs, and improvement of reconstruction accuracy [3,4,5,6,7,8,9,10]. Computer-assisted jaw reconstruction (CAJR) has benefits in reducing operation time and improving reconstruction accuracy, compared to conventional freehand jaw reconstruction. The purpose of this study was to assess surgical outcomes and learning curve for the first 58 consecutive CAJR using 3D-printed PSSP performed by a single surgical team in a single institution
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