Learning Curve Research Articles

Applying 3D Models of Giant Salamanders to Explore Form-function Relationships in Early Digit-bearing Tetrapods.

Extant salamanders are used as modern analogs of early digit-bearing tetrapods due to general similarities in morphology and ecology but the study species have been primarily terrestrial and relatively small when the earliest digit-bearing tetrapods were aquatic and an order of magnitude larger. Thus, we created a 3D computational model of underwater walking in extant Japanese giant salamanders (Andrias japonicus) using 3D photogrammetry and open-access graphics software (Blender) to broaden the range of testable hypotheses about the incipient stages of terrestrial locomotion. Our 3D model and software protocol represent the initial stages of an open-access pipeline that could serve as a "one-stop-shop" for studying locomotor function, from creating 3D models to analyzing the mechanics of locomotor gaits. While other pipelines generally require multiple software programs to accomplish the different steps in creating and analyzing computational models of locomotion, our protocol is built entirely within Blender and fully customizable with its Python scripting so users can devote more time to creating and analyzing models instead of navigating the learning curves of several software programs. The main value of our approach is that key kinematic variables (e.g., speed, stride length, elbow flexion) can be easily altered on the 3D model, allowing scientists to test hypotheses about locomotor function and conduct manipulative experiments (e.g., lengthening bones) that are difficult to perform in vivo. The accurate 3D meshes (and animations) generated through photogrammetry also provide exciting opportunities to expand the abundance and diversity of 3D digital animals available for researchers, educators, artists, conservation biologists, etc. to maximize societal impacts.

Learning curve stratified outcomes after robotic pancreatoduodenectomy: International multicenter experience

BackgroundRobotic pancreatoduodenectomy is increasingly being implemented worldwide, with good results reported from individual expert centers. However, it is unclear to what extent outcomes will continue to improve during the learning curve, as large international studies are lacking. MethodsAn international retrospective multicenter case series, including consecutive patients after robotic pancreatoduodenectomy from 18 centers in 8 countries in Europe, Asia, and South America until December 31, 2019, was conducted. A cumulative sum analysis was performed to determine the inflection points for the feasibility (operative time and blood loss) and proficiency (postoperative pancreatic fistula grade B/C and major morbidity) learning curves. Outcomes were compared in 3 groups on the basis of the learning curve inflection points. ResultsOverall, 2,186 patients after robotic pancreatoduodenectomy were included. The feasibility learning curve was reached after 30–45 robotic pancreatoduodenectomy procedures and the proficiency learning curve after 90 robotic pancreatoduodenectomy procedures. These inflection points created 3 phases, which were associated with major morbidity (24.7%, 23.4%, and 12.3%, P < .001) but not 30-day mortality (2.1%, 2.0%, and 1.5%, P = .670). Other outcomes mostly continued to improve, including median operative time 432, 390, and 300 minutes (P < .0001), conversion 6.0%, 4.7%, and 2.7% (P = .002), bile leakage 7.2%, 4.1%, and 2.4% (P < .001), postpancreatectomy hemorrhage 6.5%, 6.1%, and 1.8% (n = 21) but not R0 resection (pancreatic ductal adenocarcinoma only) 78.5%, 73.9%, and 82.8% (P = .35), and 90-day mortality rate 3.1%, 3.5%, and 2.1% (P = .191). Centers performing >20 robotic pancreatoduodenectomies annually had lower rates of conversion, reoperation, and shorter median operative time as compared with centers performing 10–20 robotic pancreatoduodenectomies annually. ConclusionThis international multicenter study demonstrates that most outcomes of robotic pancreatoduodenectomy continued to improve during 3 learning curve phases without a negative effect on 90-day mortality. Randomized studies are needed in high-volume centers that have surpassed the first learning curves, to compare these outcomes with the open approach.

Machine learning models to predict osteonecrosis in patients with femoral neck fractures undergoing internal fixation

ObjectiveThis study aimed to use machine learning (ML) to establish risk factor and prediction models of osteonecrosis of the femoral head (ONFH) in patients with femoral neck fractures (FNFs) after internal fixation. MethodsWe retrospectively collected clinical data of patients with FNFs who were followed up for at least 2 years. Only intracapsular FNFs were included. In total, 437 patients and 24 variables were enrolled. The entire dataset was divided into training (89.5%) and test (10.5%) datasets. Six models—logistic regression, naive Bayes, decision tree, random forest, multilayer perceptron, and AdaBoost—were established and validated for predicting postoperative ONFH. We compared the area under the receiver operating characteristic curve (AUC), accuracy, recall, and F1 score of different models. In addition, a confusion matrix, density curve, and learning curve were used to evaluate the model performance. ResultsThe logistic regression model performed best at predicting ONFH in patients with FNFs undergoing internal fixation surgery, with an AUC, accuracy, recall, F1 score, and prediction value of 0.84, 0.89, 1.00, 0.94, and 89.1%, respectively. The learning and density curves demonstrated a good prediction fitting degree and distinct separation. When establishing the ML models, the reduction quality, internal fixation removal, American Society of Anesthesiologists classification, injury mechanism, and displacement distance of the medial cortex were the top five risk factors positively correlated with the occurrence of ONFH. ConclusionsThe logistic regression model had excellent performance in predicting ONFH in patients with FNFs after internal fixation and could provide valuable guidance in clinical decision-making. When choosing treatment options for patients with FNFs, doctors should identify the risk factors and consider using the presented models to help anticipate outcomes and select individualised treatment.

From Novice to Mastery: Learning Curve and Efficacy Analysis of Short-Term Spinal Cord Stimulation for Diabetic Foot Ulcers

To analyze the learning curve of novices in mastering short-term Spinal cord stimulation (st-SCS) for diabetic foot, evaluating the efficacy, safety, and difficulty of this technique. A retrospective review of diabetic foot patients treated with st-SCS at our hospital was conducted. All procedures were performed by the same physician and patients were sequentially numbered according to the order of surgery. Learning curves were plotted using segmented linear regression and cumulative sum curves based on surgery duration. Patients were divided into 2 groups according to the inflection points on the learning curve: the learning group and the mastery group. Pre- and postoperative efficacy indicators were recorded and compared, along with general patient data, perioperative parameters, and incidence of complications. A total of 36 patients were included. Significant improvements were observed post-st-SCS in ulcer size (from 7.00cm2 to 4.00cm2), visual analog scale (from 7.00 to 3.00), foot temperature (from 30.06°C to 32.37°C), and Pittsburgh Sleep Quality Index (from 14.42 to 8.36) (P < 0.05). The physician could proficiently perform st-SCS after 9 cases. Surgery time was significantly shorter in the mastery group (1-9 cases) compared to the learning group (10-36 cases) (28.04 vs. 43.56min, P < 0.05). There were no significant differences between the 2 groups in baseline data, improvement in efficacy indicators, or complications (P > 0.05). St-SCS is beneficial for wound healing, pain relief, improving peripheral circulation, and improving sleep quality. Surgeons can master this simple and safe technique in about 9 cases.

Fully-inductive link prediction with path-based graph neural network: A comparative analysis

Recently, fully-inductive link prediction in knowledge graphs (KGs) has aimed to predict missing links between unseen-unseen entities, independently completing evolving KGs. The latest literature emphasizes path-based graph neural network (GNN) methods, which combine traditional path-based methods with popular GNN methods, possessing generalization capability, interpretability, scalability, and high model capacity under the inductive setting. This paper presents the first comparative analysis of fully-inductive link prediction using path-based GNNs. First, we comprehensively review and summarize the research of six relevant models, divided into relational digraph-based models and Bellman-Ford algorithm-based models. Based on this, we conduct a comprehensive analysis of these models in terms of effectiveness and efficiency (including runtime, memory, and learning curves), and compared them with two subgraph-based models. Furthermore, we delve into the impact of factors such as message functions, aggregation functions, and negative sampling in the loss function on path-based GNNs. Finally, we provide an outlook on future research directions.

Representative Sample Size for Estimating Saturated Hydraulic Conductivity via Machine Learning: A Proof‐Of‐Concept Study

AbstractMachine learning (ML) has been extensively applied in various disciplines. However, not much attention has been paid to data heterogeneity in databases and number of samples used to train ML models in hydrology. In this study, we addressed these issues and their impacts on the accuracy and reliability of ML models in the estimation of saturated hydraulic conductivity, Ks. We selected 17,990 soil samples from the USKSAT database and created random subsets N = 2,000, 4,000, 6,000, 8,000, 10,000, 12,000, 14,000, 16,000, and 17,990, 80% of which were used for training. The random subset selection was repeated 50 times. The extreme gradient boosting (XGBoost) algorithm was used to estimate Ks from other soil properties, such as bulk density, soil depth, texture, and organic content. For each subset, we conducted the learning curve analysis on the training and cross‐validation data sets. Results showed that for all training sample sizes the number of samples was not enough for the training and cross‐validation curves to reach a plateau. We also applied the concept of representative elementary volume by plotting the average coefficient of determination, R2, and root mean square log‐transformed error, RMSLE, against the training sample size. For the testing data set, as the number of training sample size increased from 1,600 to 14,392 the average R2 value increased from 0.74 to 0.90, while the average RMSLE value decreased from 1.08 to 0.69. Either the learning curve or representative sample size analysis is required to investigate whether the number of samples is enough or not.

Evaluation of learning curves for contact laser vaporization of the prostate using the 980 nm diode laser for benign prostatic hyperplasia.

We investigated the background of patients who underwent contact laser vaporization of the prostate (CVP) surgery and the learning curve of the operators. A total of 207 patients who underwent CVP surgery for benign prostatic hyperplasia between August 2018 and March 2023 were included in this study. Patient background, perioperative results, pre- and postoperative urinary flow tests, and complications were collected retrospectively. We enrolled 12 doctors who were divided into expert (five doctors) and novice (seven doctors) groups based on the number of TURP experiences before CVP. The median patient age was 73 years (51-92 years) and prostate volume was 56 cc (15-190 cc) with no difference between the expert and novice groups. Complications included urinary retention (eight cases), hematuria (four), urinary tract infection (four), intraoperative perforation (two), and postoperative stricture (one). Both cases of intraoperative perforation occurred in the novice group. The expert group had a significantly shorter operative time (38 vs. 66 min) and a higher operative efficacy of prostate volume divided by operative time (1.43 vs. 0.88 cc/min). Postoperatively, IPSS, quality of life scores, and postvoid residual urine volume decreased, and maximal flow rate increased; however, there was no significant difference between the groups. The expert group showed stable operative time and operative efficacy after about five to eight cases, while the novice group showed stable after about 15 cases. Our findings suggest that CVP was safely performed at our hospital, and operators with limited experience in TURP can achieve stable perioperative results.

Continued improvement to imaging diagnosis and treatment triage of endometriosis: The role of the multi-disciplinary conference

Patient-centered endometriosis management tailored to the individual patient's subset of symptoms often requires highly sensitive and specific preoperative imaging. In the setting of a present ongoing learning curve among radiologists who interpret pelvis ultrasounds and MRIs for diagnosis of endometriosis, we have found that routine feedback between minimally invasive gynecology surgeons and radiologists, based on pre-operative imaging and postoperative laparoscopic findings, is essential for the continual improvement of imaging-based staging of endometriosis and empower pre-operative imaging as an important pillar of endometriosis management. We share illustrative patient cases, which, after collaborative discussion during our routine multi-institutional, multi-disciplinary conferences (MDCs) have led to improved patient counseling, better pre-surgical planning, and therefore improved patient satisfaction. Our endometriosis MDCs will continue to improve patient management in the future by providing a forum for trainees in medical, surgical, imaging, and pathology specialties to gain expertise directly from subspecialists, and participate in the care of these patients.

Effective and safe implementation of robot-assisted donor nephrectomy by experienced laparoscopic surgeons.

In June 2021, the first robot-assisted donor nephrectomy (RADN) was performed at the Leiden University Medical Center (LUMC), the Netherlands. The goal of this study was to investigate whether this procedure has been implemented safely and efficiently. RADN was retrospectively compared to laparoscopic donor nephrectomy (LDN) performed during the same time period (June 2021 until November 2022). Patients were assigned to RADN depending on the availability of the da Vinci robot and surgical team. The studied endpoints were postoperative complications, operative time, estimated blood loss, warm ischemic time (WIT), and postoperative pain experience. For analysis, the Student's t-test and Chi-squared test were used for, respectively, continuous and categorical data. Forty RADN were compared to 63 LDN. Total insufflation time was significantly longer in RADN compared to LDN (188min (169-214) versus 172min (144-194); p=0.02). Additionally, WIT was also found to be significantly higher in the robot-assisted group (04:54min vs. 04:07min; p<0.01). No statistical differences were found in postoperative outcomes (eGFR of the recipient at 3-month follow-up, RADN 54.08mL/min ±18.79 vs. LDN 56.41mL/min ±16.82; p=0.52), pain experience, and complication rate. RADN was safely and efficiently implemented at the LUMC. It's results were not inferior to laparoscopic donor nephrectomy. Operative time and warm ischemic times were longer in RADN. This may relate to a learning curve effect. No clinically relevant effect on postoperative outcomes was observed.

Comparison Between Resident and Attending Surgeons as Assistants on Adolescent Idiopathic Scoliosis Surgery: No Differences in Outcomes, Complications Rate, or Pedicle Screw Placement Accuracy.

Retrospective cohort study. The aim of the present study was to determine if the level of training of the first assistant (resident or attending surgeon) has an influence on the radiographic outcome of AIS surgery and on the accuracy rate of the pedicle screws placement. Adolescent idiopathic scoliosis (AIS) surgery is a challenging procedure that requires a dedicated team of skilled professionals. Therefore, understanding the learning curve is of outstanding importance to guarantee the best outcomes and the highest safety to the patients. A retrospective analysis of patients who underwent surgery for AIS with a minimum follow-up of 2 years was conducted. All patients were operated by an experienced spine surgeon, assisted by and attending surgeon (group A) or a senior resident (group B). Radiographic outcomes were assessed. Through postoperative CT scan, accuracy of pedicle screw placement was measured (using Gertzbein-Robbins classification). Groups were then statistically compared. A total of 120 patients were included (mean age 15.3±3.39y, major curve Cobb 60.7±11.9 degrees). No difference was found between groups in terms of preoperative characteristics and postoperative radiographic (correction rate, thoracic kyphosis, screw density) outcomes or complications. Operative time and estimated blood loss were significantly higher in Group B (P=0.045 and P=0.024, respectively). Of the 2746 pedicle screws inserted (1319 group A and 1427 group B), 2452 had a perfect intrapedicular trajectory (absolute accuracy of 89.29%) and 2697 had a breach <2mm (relative accuracy of 97.56%). No difference was found among groups in terms of absolute or relative accuracy (P=0.06 and P=0.23, respectively). AIS cases assisted by senior residents have longer operative time and higher blood loss, but this does not negatively affect the overall radiographic outcome and does not place the patient at increased risk of complications. III.

Lure: A simulator for networks of batteryless intermittent nodes

The emerging paradigm of batteryless intermittent sensor networks (BISNs) presents new challenges for researchers of low-power wireless systems and protocols. The nature of these challenges exacerbates the difficulty of evaluating networks of physical sensor nodes, making simulation an even more important component in evaluating performance metrics, such as communication throughput and delay, for BISN designs. To our knowledge, existing simulators and analytical models do not meet the unique needs of BISN research; therefore, we have created a new open-source BISN simulator named Lure. Lure is designed from the ground-up for simulation of batteryless intermittent systems and networks. Written in Python, Lure is powerful, flexible, highly configurable, and supports rapid prototyping of new protocols, systems, and applications, with a low learning curve. In this paper, we present Lure and validate it with experimental data to show that Lure can accurately reflect the reality of BISNs. We then demonstrate the process of applying Lure to research questions in select case studies.

Influence of specialization on primary success and complication rate in ERCP. Proposal to improve the quality of ERCP

Endoscopic retrograde cholangiopancreatography [ERCP] is a complex procedure with a flat learning curve. It is associated with the risk of serious complications such as pancreatitis, bleeding, cholangitis and perforation. Endosonography should therefore also be offered for the precise indication of the higher-risk ERCP. Numerous factors influence the success of ERCP. In addition to structured training for the initial acquisition of skills and a minimum number of ERCPs of varying degrees of difficulty, maintaining a good quality of ERCP also requires a regular minimum number of examinations performed per year. There is extensive evidence that shows a significant correlation between ERCP volumes and primary success rates, lower lengths of hospital stay, fewer unwanted readmissions and fewer complications. The cut-offs for differentiating between high-volume and low-volume centers were chosen inconsistently in the studies, with the highest evidence for a cut-off value of 200 ERCPs/year. The question of specialization in ERCP has been given a relevance by the current developments in german hospital reform. Here, a minimum number of ERCPs should be defined for groups of different specialization. However, a minimum number alone will not be able to achieve good treatment quality. In terms of high-quality patient care, it is necessary to offer ERCPs in specialized gastroenterology center, which, in addition to a sufficient number of ERCPs for training and to maintain competence, offer an on-call service and complementary procedures such as EUS and which are embedded in appropriately accessible clinics that have the necessary resources for complication management.

Setting Sail in Hip Arthroscopy: The “Rudder Technique” for Spinal Needle Access Through the Mid-anterior Portal

Hip arthroscopy is a technically demanding procedure with a steep learning curve. Even accessing the hip joint, if performed improperly, will make the remainder of the case more difficult and potentially cause iatrogenic injury. Much like the rudder of a boat, the spinal needle bevel edge can be steered through tissue in a manner to ensure smooth sailing when accessing the hip. The purpose of this article is to provide a better understanding of how to maximize the capabilities of a bevel-edge needle through use of the “rudder technique” to gain access in a more efficient and atraumatic fashion.

Use of piezoelectric instrumentation in craniofacial surgery.

The use of piezoelectric instrumentation is increasingly recognized as an alternative to traditional bone-cutting techniques across a wide array of surgeries. Here, we provide an overview of the technique, including device principles, benefits, and drawbacks. We also review its use in craniofacial surgery. Piezoelectric surgery is a minimally invasive bone-cutting system with lower risk of damage to surrounding soft tissue structures. Indications for its use are rapidly expanding across multiple fields, including craniofacial surgery. To date, piezosurgical techniques have been most widely adopted and studied in the contexts of rhinoplasty, orthognathic surgery, and cranioplasty in craniosynostosis. Piezosurgery can facilitate more precise and consistent osteotomies while decreasing morbidities associated with traditional osteotomy techniques. Primary limitations include cost and concerns regarding increased operative times secondary to operator learning curves and decreased cutting efficiency. Piezoelectric surgery represents an alternative to traditional bone-cutting modalities to improve precision, consistency, and safety of osteotomies. Further research is needed to better understand the efficacy of the technique as well as potential for additional applications.

Deep integration of low-cost liquid handling robots in an industrial pharmaceutical development environment

The pharmaceutical industry is increasingly embracing laboratory automation to enhance experimental efficiency and operational resilience, particularly through the integration of automated liquid handlers (ALHs). This paper explores the integration of the low-cost Opentrons OT-2 liquid handling robot with F. Hoffmann-La Roche AG's in-house workflow orchestration software, AutoLab, to overcome barriers to lab automation. By leveraging the OT-2′s development-oriented interfaces and AutoLab's modular architecture, we achieved a user-friendly, cost-efficient, and flexible automation solution that aligns with FAIR (findable, accessible, interoperable, reusable) data principles. We demonstrate an advanced workflow development methodology, utilizing the software architecture, that facilitates the creation of two flexible pipetting protocols and medium complexity assays. This deep integration approach diminishes the learning curve for novice users while simultaneously enhancing the overall efficiency and reliability of the experimental workflow. Our findings suggest that such integrations can significantly mitigate the challenges associated with lab automation, including cost, complexity, and adaptability, paving the way for more accessible and robust automated systems in pharmaceutical research.

Medicolegal implications of robotics in spine surgery

Robotic assistance for spine surgery has seen a resurgence in the last decade, with numerous navigation-integrated robotic systems now available for commercial use. This paper briefly reviews the historical context of robotic surgery, summarizes the current robotic spine surgery platforms, and outlines medicolegal implications and general trends of litigation for spine surgery as they relate to robotic navigation. The focus of this review is on pedicle screw instrumentation, complications, and the learning curve for robotic navigation, and how these aspects relate to medical malpractice claims.

Ultrasonographic Assessment of Optic Nerve Sheath Diameter as a Screening Tool for Intracranial Hypertension in Traumatic Brain Injury

BackgroundSevere traumatic brain injury (TBI) is a condition burdened by high morbidity and mortality. Prevention of secondary insults is one of the main goals of management and intracranial pressure monitoring is a cornerstone in management of TBI. The relationship between intracranial pressure and optic nerve sheath is known from the literature. Optic nerve sheath ultrasonography could represent a method added to our armamentarium for monitoring intracranial pressure. MethodsWe investigated how ultrasound-measured optic nerve sheath diameter varies as a function of intracranial pressure in a cohort of patients with severe blunt head injury in whom an intraparenchymal sensor was placed. We evaluated the accuracy of optic nerve sheet diameter (ONSD) in distinguishing dichotomized ICP cut-offs and analyzed the learning curve and its potential as screening tool to select TBI patients most in need of invasive ICP monitoring in a setting with constraints on resources. ResultsONSD and ICP have a linear relationship. Nevertheless, there are limits of evaluating the one-to-one correspondence between those two variables. We selected a cut-off of sonographic ONSD above which there is a concernable elevation of intracranial pressure (ICP>15 mmHg) worthy of invasive second line invasive monitoring. Thus, it is possible to use ONSD as a first line non-invasive tool to intercept patients at risk of developing frank intracranial hypertension. ConclusionsWe propose the use of ONSD ultrasound as a screening investigation for post-traumatic intracranial hypertension in the context of an emergency department, especially in contexts where there is limited availability of intracranial pressure monitors.

Video-Based Performance Analysis in Pituitary Surgery—Part 1: Surgical Outcomes

Endoscopic pituitary adenoma surgery has a steep learning curve, with varying surgical techniques and outcomes across centers. In other surgeries, superior performance is linked with superior surgical outcomes. This study aimed to explore the prediction of patient-specific outcomes using surgical video analysis in pituitary surgery. Endoscopic pituitary adenoma surgery videos from a single center were annotated by experts for surgical workflow (3 phases, 15 steps) and surgical skill (using modified Objective Structured Assessment of Technical Skills; mOSATS). Quantitative workflow metrics were calculated, including phase duration and step transitions. Poisson or logistic regression was used to assess the association of workflow metrics and mOSATS with common inpatient surgical outcomes. 100 videos from 100 patients were included. Nasal phase mean duration was 24mins and mean mOSATS was 21.2/30. Mean duration was 34mins and mean mOSATS was 20.9/30 for the sellar phase, and 11mins and 21.7/30 respectively for the closure phase. The most common adverse outcomes were new anterior pituitary hormone deficiency (n=26), dysnatremia (n=24) and cerebrospinal fluid (CSF) leak (n=5). Higher mOSATS for all three phases and shorter operation duration was associated with decreased length of stay (p=0.003 & p<0.001). Superior closure phase mOSATS were associated with reduced post-operative CSF leak (p<0.001), and superior sellar phase mOSATS were associated with reduced post-operative visual deterioration (p=0.041). Superior surgical skill and shorter surgical time were associated with superior surgical outcomes, at a generic and phase-specific level. Such video-based analysis has promise for integration into data-driven training and service improvement initiatives.

Experience Curve With the Cone Procedure for Ebstein’s Anomaly: Effect on Cost and Resource Utilization

BackgroundThe volume-outcome relationship is well-known in health care. The Experience Curve, initially developed by the Boston Consulting Group for manufacturing, offers insight on this relationship and has never before been applied to health care. ObjectivesThe purpose of this study was to determine the effect of experience on cost and resource utilization for the Cone procedure. MethodsWe performed a retrospective review of patients who underwent Cone reconstruction for Ebstein’s anomaly at Boston Children’s Hospital between October 2010 and October 2021. Cardiopulmonary bypass time and aortic cross clamp time over time were evaluated using exponential regression to assess the surgeon-level learning curve. At the hospital level, length of stay and cost over time were assessed using exponential regression. ResultsThere were 115 patients included in the study. Median hospital length of stay was 7.9 days (IQR: 6.4-10.2 days) with a decline of 3.3% per year. Median intensive care unit [ICU] length of stay was 3.2 days (IQR: 2-5.7 days) with a decline of 10.5% per year. Adjusted direct costs indexed to 2020 prices fell by 4% per year. There was no statistically significant change in cardiopulmonary bypass or aortic cross clamp time. In mediation analysis, the reduction in cost was completely accounted for in the decline in ICU length of stay. ICU length of stay was correlated with duration of intubation. ConclusionsIncreasing familiarity with Ebstein’s anomaly and Cone reconstruction led to a reduction in resource utilization.

Preauricular versus intraoral condylectomy for the treatment of unilateral condylar hyperactivity

In this study we retrospectively reviewed our clinic’s experience in treating Unilateral Condylar Hyperactivity (UCH) by computer-guided proportional condylectomy conducted both through preauricular and intraoral approaches and analysed advantages and disadvantages of the two techniques. A computer-guided treatment algorithm is also presented.We enrolled forty-two patients diagnosed with clinical asymmetry, with or without associated dentofacial deformities, and confirmed by Single photon emission computed tomography (SPECT) UCH, who underwent proportional condylectomy: twenty-six of them underwent isolated proportional condylectomy, while sixteen underwent proportional condylectomy with concomitant orthognathic surgery.The intraoral approach demonstrates a capacity and precision that is nearly equivalent to the extraoral approach when conducting a proportional condylectomy. This mitigates the significant surgical risks associated with the extraoral approach. However, it’s important to acknowledge the learning curve associated with this approach. Utilizing Virtual Surgical Planning (VSP) and custom cutting guides is essential.