Impact Of Surgical Experience Research Articles

Endourologists vs urologists: The impact of surgical experience and annual case volume on percutaneous nephrolithotomy outcomes

Background/Aim: Surgeon experience, which is an important factor in reducing surgical complications, has been underestimated when analysing percutaneous nephrolithotomy (PNL) outcomes. Aim of this study was to investigate the impact of annual case volume (ACV) of endourologists and urologists on PNL outcomes including stone-free status (SFS) and complications. Methods: A total of 530 patients who underwent PNL in the Clinic between January 2018 and January 2023 were retrospectively analysed. The patients were divided into two groups: those operated by endourologists (Group 1, n = 324) and by urologists (Group 2, n = 206). The two groups were statistically compared in terms of postoperative SFS and complications. Results: There were two endourologists in Group 1 and four urologists in Group 2. The mean ACV was 73.56 ± 7.43 in Group 1 and 23.81 ± 9.09 in Group 2, indicating a statistically significantly higher rate in Group 1 (p < 0.001). There was no statistically significant difference in the postoperative SFS rates between the groups (p = 0.064). In the perioperative period, the mean estimated blood loss and nephrostomy dwell time were significantly lower in Group 1 than Group 2 (p = 0.013 and p = 0.008, respectively). In the logistic regression analysis, a cut-off value of > 24 for ACV and CROES scores were the significant predictors of SFS (p = 0.004 and p < 0.001, respectively). The complication rate was significantly lower among surgeons with an ACV of > 24 (p < 0.001). Conclusion: Results from this study showed that an ACV of > 24 increases SFS rate by 2.13 with lower complication rates in patients undergoing PNL. Further multi-centre, large-scale studies are required to investigate the effect of surgical experience and ACV on postoperative outcomes and to predict PNL outcomes with high accuracy.

Impact of Surgical Experience Before Robot-assisted Partial Nephrectomy on Surgical Outcomes: A Multicenter Analysis of 2500 Patients

BackgroundRobot-assisted partial nephrectomy (RAPN) is a challenging procedure that is influenced by a multitude of factors. ObjectiveTo assess the impact of prior surgical experience on perioperative outcomes in RAPN. Design, setting, and participantsIn this retrospective multicenter study, results for 2548 RAPNs performed by 25 surgeons at eight robotic referral centers were analyzed. Perioperative data for all consecutive RAPNs from the start of each individual surgeon’s experience were collected, as well as the number of prior open or laparoscopic kidney surgeries, pelvic surgeries (open, laparoscopic, robotic), and other robotic interventions. InterventionTransperitoneal or retroperitoneal RAPN. Outcome measurements and statistical analysisThe impact of prior surgical experience on operative time, warm ischemia time (WIT), major complications, and margin, ischemia, complication (MIC) score (negative surgical margins, WIT ≤20 min, no major complications) was assessed via univariate and multivariable regression analyses accounting for age, gender, body mass index (BMI), American Society of Anesthesiologists score, PADUA score, and RAPN experience. Results and limitationsBMI, PADUA score, and surgical experience in RAPN had a strong impact on perioperative outcomes. A plateau effect for the learning curve was not observed. Prior laparoscopic kidney surgery significantly reduced the operative time (p < 0.001) and WIT (p < 0.001) and improved the MIC rate (p = 0.022). A greater number of prior robotic pelvic interventions decreased WIT (p = 0.011) and the rate of major complications (p < 0.001) and increased the MIC rate (p = 0.011), while prior experience in open kidney surgery did not. One limitation is the short-term follow-up. ConclusionsMastering of RAPN is an ongoing learning process. However, prior experience in laparoscopic kidney and robot-assisted pelvic surgery seems to improve perioperative outcomes for surgeons when starting with RAPN, while experience in open surgery might not be crucial. Patient summaryIn this multicenter analysis, we found that a high degree of experience in keyhole kidney surgery and robot-assisted pelvic surgery helps surgeons in achieving good initial outcomes when starting robot-assisted kidney surgery.

The Impact of Surgical Experience in VATS Lobectomy on the Conversion and the Patient Quality of Life: Results from a Comprehensive National Video-Assisted Thoracic Surgical Database

The Impact of Surgical Experience in VATS Lobectomy on the Conversion and the Patient Quality of Life: Results from a Comprehensive National Video-Assisted Thoracic Surgical Database

Impact of Surgical Experience on Hysterectomy Outcomes; A Venture to Improve the Linear Curve, Surgical Outcome, and Cost-Effectiveness: A Retrospective Study

Impact of Surgical Experience on Hysterectomy Outcomes; A Venture to Improve the Linear Curve, Surgical Outcome, and Cost-Effectiveness: A Retrospective Study

Does experience of the surgeon affect surgical margins in head and neck basal cell carcinoma?

&lt;b&gt;Aim:&lt;/b&gt; The aim of our study was to evaluate the impact of surgical experience in a high volume head and neck surgery department on basal cell carcinoma margin status. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Material and methods:&lt;/b&gt; A retrospective analysis of 546 patients surgically treated for primary basal cell carcinoma of the head and neck region was carried out. Resections were performed by 4 specialists with equal experience in head and neck surgery and 4 ENT residents at the same level of surgical training. A margin of 3-5 mm was chosen, according to guidelines. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; The study consisted of 304 males and 242 females, mean age of 69 (range 26-100). Most of the tumors were loca-ted on the nose (165 pts; 30.2%) and auricle (119; 21.7%). The most common histological subtype was nodular (119; 21.7%). Tumor size was up to 20 mm in 394 cases (72%). Positive surgical margins were found in 112 cases (20.5%). There was no difference in terms of positive surgical margins between residents (19/119 cases; 15.9%) and specialists (93/426; 21.8%; p = 0.161). &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusions:&lt;/b&gt; The results of our study have shown that adequate surgical training in a dedicated head and neck surgery de-partment is an efficient factor in obtaining free surgical margins in head and neck basal cell carcinoma.

Impact of Experience on Outcomes After Endoscopic Transsphenoidal Surgery for Acromegaly

Acromegaly is a syndrome of metabolic alterations secondary to increased growth hormone levels from a somatotroph pituitary adenoma. A multidisciplinary approach beginning with surgery, followed by adjuvant radiation or medical therapy for residual disease, is considered standard of care. Several factors affect the likelihood of remission after surgery, but the impact of surgical experience on remission rates has not been adequately assessed. Retrospective review of 203 patients, divided into 2 eras (era 1, 102 patients; era 2, 101 patients) of patients who underwent transsphenoidal surgery for acromegaly by a single surgeon over 11 years, was performed, determining the effect of surgical experience on rates of remission and various complications. Remission was defined according to the 2014 Endocrine Society Clinical Practice Guideline. The rate of surgical remission was 40.6% (62.9% among noninvasive adenomas). Rates of surgical remission significantly improved in the latter half of this cohort (31.2% in the first half vs. 50% in the second half), despite other factors being comparable. On multivariate analysis, surgeon experience, cavernous sinus invasion, and preoperative growth hormone levels affected the rates of surgical remission. Rates of cerebrospinal fluid leak and hypopituitarism were lower in the second half, whereas resolution of acromegaly-associated comorbidities was increased. We report, in this large single-surgeon review of endoscopically operated acromegaly cases, increased rates of surgical remission and reduced complications with increasing surgeon experience. The overall experience of the treating team in dealing with perioperative and intraoperative factors also contributes to improved outcomes.

Impact of surgical experience on early post-operative regional corneal thickness after phacoemulsification

Background: Currently, phacoemulsification is a very common cataract surgical procedure in which the lens is emulsified and aspirated from the eye through a small corneal incision.Aim: To compare early regional corneal thickness changes following phacoemulsification done by experienced surgeons versus trainee surgeons.Setting: A prospective cohort study was done at Ibn Al Haitham tertiary eye hospital in Baghdad, Iraq.Methods: The data were collected for 5 months, from 01 March 2018 until 31 July 2018. Adult patients undergoing phacoemulsification and intraocular lens surgery were prospectively evaluated and divided into two groups. Group 1 comprised those operated by experienced surgeons, whilst Group 2 patients were operated by trainee surgeons. Slit lamp examination and endothelial specular microscopy were assessed with the measurement of central corneal thickness (CCT) and peripheral corneal thickness (PCT), using Scheimpflug imaging (Pentacam).Results: There was a significant statistical difference in post-operative CCT between Groups 1 and 2, being 596.72 ± 50.69 µm compared to 631.54 ± 67.84 µm in Groups 1 and 2, respectively, with a mean difference of 34.82 µm (p = 0.000). More difference was observed in post-operative PCT (148.38 µm) as it was 734.8 ± 88.55 µm in the experienced group, compared to 883.18 ± 128.43 µm in the trainee group (p = 0.005).Conclusion: Phacoemulsification done by trainee surgeons was associated with higher CCT and PCT.

Impact of surgical experience on early post-operative regional corneal thickness after phacoemulsification

Background: Currently, phacoemulsification is a very common cataract surgical procedure in which the lens is emulsified and aspirated from the eye through a small corneal incision. Aim: To compare early regional corneal thickness changes following phacoemulsification done by experienced surgeons versus trainee surgeons. Setting: A prospective cohort study was done at Ibn Al Haitham tertiary eye hospital in Baghdad, Iraq. Methods: The data were collected for 5 months, from 01 March 2018 until 31 July 2018. Adult patients undergoing phacoemulsification and intraocular lens surgery were prospectively evaluated and divided into two groups. Group 1 comprised those operated by experienced surgeons, whilst Group 2 patients were operated by trainee surgeons. Slit lamp examination and endothelial specular microscopy were assessed with the measurement of central corneal thickness (CCT) and peripheral corneal thickness (PCT), using Scheimpflug imaging (Pentacam). Results: There was a significant statistical difference in post-operative CCT between Groups 1 and 2, being 596.72 ± 50.69 µ m compared to 631.54 ± 67.84 µ m in Groups 1 and 2, respectively, with a mean difference of 34.82 µ m ( p = 0.000). More difference was observed in post-operative PCT (148.38 µ m) as it was 734.8 ± 88.55 µ m in the experienced group, compared to 883.18 ± 128.43 µ m in the trainee group ( p = 0.005). Conclusion: Phacoemulsification done by trainee surgeons was associated with higher CCT and PCT.

Impact of Surgical Experience on Operative Mortality After Reoperative Cardiac Surgery

Learning curves and skill attrition with aging have been reported to impair outcomes in select surgical subspecialties, but their role in complex cardiac surgery remains unknown. From 1986 to 2019, 2314 patients underwent reoperative cardiac surgery: coronary artery bypass grafting (n= 543), valve (n= 1527), or combined coronary artery bypass grafting and valve (n= 244). Thirty-four different surgeons in practice between 1 and 39 years were included. Standardized mortality ratio (observed-to-expected) was determined for all surgeons in each post-training year of experience. Risk-adjusted cumulative sum change-point analysis was used to define five distinct career phases: 0 to 4 years, 5 to 8 years, 9 to 17 years, 18 to 28 years, and 29 to 39 years. With 5 to 8 years and 18 to 28 years of experience, standardized mortality ratio was near unity (0.95 and 1.05, respectively) and lowest with 9 to 17 years of experience (0.78, P= .03). In the youngest experience group (0 to 4 years), observed and expected mortality were both highest, and standardized mortality ratio was elevated at 1.29, which approached statistical significance (P= .059). In the oldest experience group (29 to 39 years), expected mortality was low compared with most other groups but observed mortality increased, yielding a significantly elevated standardized mortality ratio at 1.53 (P= .032). Standardized mortality ratios with reoperative cardiac surgery were highest early and late in a surgeon's career and lowest in mid career. As surgeons gain experience, outcomes improve through the first two career decades, then stabilize in the third decade before declining in the fourth decade.

The impact of surgical experience on complications of laparoscopic cholecystectomy

Objective: Laparoscopic cholecystectomy (LC) is the gold standard option for the surgical treatment of cholecystitis. Meanwhile, experience of surgical center and operator play central role in adequate management of patients with gallbladder disorders. The aim of this study is to analyze complications and conversion rates of laparoscopic cholecystectomy at various periods of implication of the method in a single center. Methods: We retrospectively analyzed early complications of 6381 patients operated due to various forms of cholecystitis according to periods of implication of LC in Kyrgyz National Center of General Surgery (1996-2019). Patients were divided into 3 groups: first group of patients were operated from 1996 to 2004 during first implementation of technique (n=1446); second group patients underwent operation between 2005-2008, when operators concentrated on technical skills (n=1225); third group of patients operated between 2009 and 2019, when surgical team concentrated on prevention of complications. Results: Both complication and conversion cases represented strong association with surgical experience. The highest complications (4.8% vs 1.5% and 0.4%, respectively, p&amp;lt;0.001) and conversion to surgical cholecystectomy (11.2% vs 1.5% and 0.1%, respectively, p=0.001) rates were detected in group 1 as compared to groups 2 and 3. Conclusion: Occurrence of complications and conversion to conventional surgical cholecystectomy reduced over time, depending on surgical experience of operating team and practice of operator.

Re: The Learning Curve for Robot-Assisted Partial Nephrectomy: Impact of Surgical Experience on Perioperative Outcomes.

Re: The Learning Curve for Robot-Assisted Partial Nephrectomy: Impact of Surgical Experience on Perioperative Outcomes.

220 - The impact of surgical experience on the risk of surgical margins and biochemical recurrence after robot-assisted radical prostatectomy: A learning-curve study

220 - The impact of surgical experience on the risk of surgical margins and biochemical recurrence after robot-assisted radical prostatectomy: A learning-curve study

The Learning Curve for Robot-assisted Partial Nephrectomy: Impact of Surgical Experience on Perioperative Outcomes

Robot-assisted partial nephrectomy (RAPN) outcomes might be importantly affected by increasing surgical experience (EXP). The aim of the study is to investigate the effect of EXP on warm ischemia time (WIT), presence of at least one Clavien-Dindo ≥2 postoperative complication (CD ≥ 2), and positive surgical margins (PSMs) to define the learning curve for RAPN. We evaluated 457 consecutive patients diagnosed with a cT1-T2 renal mass were evaluated. EXP was defined as the total number of RAPNs performed by each surgeon before each patient's operation. Median WIT was 14min and the rate of CD ≥ 2 and PSMs was 15% and 4%, respectively. At multivariable regression analyses adjusted for case mix, EXP resulted associated with shorter WIT (p<0.0001) and higher probability of CD ≥ 2–free postoperative course (p=0.001), but not with PSMs (p=0.7). The relationship between EXP and WIT emerged as nonlinear, with a steep slope reduction within the first 100 cases and a plateau observed after 150 cases. Conversely, the relationship between EXP and CD ≥ 2–free course resulted linear, without reaching a plateau, even after 300 cases.Patient summary: Perioperative outcomes after robot-assisted partial nephrectomy (RAPN) are importantly and individually affected by surgeon's experience. After 150 RAPNs, no further improvement is observed with respect to ischemia time, but the learning curve appears endless with respect to complications.

P28 - The impact of surgical experience on radiation exposure during retrograde intrarenal surgery: Findings from a cross sectional study

P28 - The impact of surgical experience on radiation exposure during retrograde intrarenal surgery: Findings from a cross sectional study

PE50 - The learning curve for robot-assisted partial nephrectomy: Impact of surgical experience on perioperative outcomes

PE50 - The learning curve for robot-assisted partial nephrectomy: Impact of surgical experience on perioperative outcomes

P144 - The learning curve for robot-assisted partial nephrectomy: Impact of surgical experience on perioperative outcomes

P144 - The learning curve for robot-assisted partial nephrectomy: Impact of surgical experience on perioperative outcomes

Perinatal outcomes after open fetal surgery for myelomeningocele repair: a retrospective cohort study.

ObjectiveDescribe outcomes of open fetal surgery for myelomeningocele (MMC) repair in two Brazilian hospitals and the impact of surgical experience on outcome.DesignRetrospective cohort study.SettingSao Paulo, Brazil.Population237 pregnant women carrying a fetus with an open spinal defect.MethodsSurgical details, and maternal and fetal outcomes collected from all patients.Main outcome measuresAnalysis of surgical and perinatal outcome parameters.ResultsTotal surgical time was 119 ± 7.6 minutes. Preterm labour occurred in 24.2%, premature rupture of membranes in 26.7%, placental abruption in 0.8%, need for a blood transfusion at delivery in 2.1%, and dehiscence at the repair site in 2.5%. Reversal of hindbrain herniation at birth occurred in 71.4%. There were no maternal deaths or severe maternal morbidities. The failure rate with the patient anaesthetised was 0.42% and perinatal mortality was 2.1% (three intrauterine demises and two neonatal deaths). Comparing results from our study in the first 3 years with the last 3 years demonstrated improvement in the total surgical time (121.2 ± 6.4 versus 118.5 ± 8.2 minutes, P = 0.005) and an increase in reversal of hindbrain herniation at birth (64.0 versus 77.1%, P = 0.042).ConclusionOur open fetal surgical approach for MMC was effective and results were comparable to past studies. Improvements in surgical performance and perinatal outcome increased as the surgical team became more familiar with the procedure.FundingThe study was funded solely by institutional funds.Tweetable abstractBrazilian experience of in utero open surgery for myelomeningocele repair.

The impact of surgical experience and work routine on in-hospital morbidity and mortality in pancreatic surgery

The impact of surgical experience and work routine on in-hospital morbidity and mortality in pancreatic surgery

907 - The learning curve for robot-assisted partial nephrectomy: Impact of surgical experience on perioperative outcomes

907 - The learning curve for robot-assisted partial nephrectomy: Impact of surgical experience on perioperative outcomes

Venous Resection in Pancreatic Ductal Adenocarcinoma: Impact of Surgical Experience on Early Postoperative Courses.

The aim of this study was to determine the effects of surgical experience on early postoperative courses after pancreaticoduodenectomy (PD) with venous resection. From 2005 to 2014, 134 patients were analyzed, 62 and 72 patients were resected in periods 1 (2005-2009) and 2 (2010-2014) respectively; 115 and 19 patients underwent PD with venous resection in high- and low-volume center groups respectively. Of the entire cohort, mortality rate was 4%. There were no significant differences between the two periods. In the low-volume center group, the mortality rate was increased (21% vs. 2%, p<0.01) and the mean length of hospital stay was longer (25 (±27) days vs. 17 (±8) days, p=0.04). The high-volume center group was the only independent protective factor regarding death (OR=0.04, 95%CI (0.01-0.38), p<0.01) and length of hospital stay (OR<0.01, 95%CI (0.00-0.43), p=0.03). Patients who present isolated venous invasion must be referred to high-volume centers for surgery.