Short Learning Curve Research Articles

Modified Canabrava technique with a 4-closed loop intraocular lens injected into the anterior chamber

The goal of this study was to describe and assess the efficacy of a new modification for scleral fixation of a 4-eyelet foldable intraocular lens (IOL) using a previous IOL injector in the anterior chamber. An uncontrolled case series was used to investigate the efficacy of this new modification of the original Canabrava technique. Intraocular pressure and visual acuity data were obtained preoperatively and postoperatively. Surgeries were performed with the new modification of the Canabrava technique in 12 patients with implantation incisions as small as 2.2 mm (3.2 to 2.2 mm). The follow-up period ranged from 1 to 13 months. Corrected distance visual acuity improved significantly in all 12 patients, from 0.38 to 0.31 logMAR, whereas the cell count from specular microscopy decreased in average (preoperatively 2191 cells/mm2; postoperatively 1843 cells/mm2) and median (preoperatively 2225 cells/mm2; postoperatively 1902 cells/mm2). This current modification of the Canabrava technique greatly simplifies the procedure, making it easier and faster and with a shorter learning curve.

Robotic Versus Open Distal Pancreatectomy: A Propensity Score Matching Analysis.

Minimally invasive distal pancreatectomy offers recognised benefits over open surgery. Robotic surgery, with its shorter learning curve and technical advancements, presents a promising alternative to laparoscopy in managing pancreatic diseases. This study enrolled consecutive patients undergoing distal pancreatectomy between January 2013 and May 2022. After propensity score matching, perioperative and medium-term outcomes were compared between robotic and open procedures. Among 79 patients analysed, 50 were eligible after matching. Both groups showed similar demographics, with 11% experiencing grade III-IV complications, and one patient died within 90days after surgery. Robotic surgery exhibited longer operating times but allowed for earlier refeeding, drain removal, canalisation, and shorter hospital stays compared with open surgery. Spleen preservation rates, postoperative pancreatic fistula occurrences and survival were comparable between the groups. Overall, robotic and open distal pancreatectomy demonstrated similar outcomes, with robotic surgery offering advantages in certain postoperative parameters despite longer operation times.

The learning curve for hood‐sparing robotic‐assisted radical prostatectomy: A single‐surgeon experience

AbstractObjectivesThis study aimed to assess the impact of anterior hood‐sparing robot‐assisted radical prostatectomy (RARP) with posterior‐anterior reconstruction in a single‐surgeon series by analysing oncological and functional continence outcomes.Patients and MethodsWe carried out a cohort comparison study of a prospectively collected single‐surgeon series. The surgeon was an ‘in‐training’ fellowship trained surgeon in their first 2 years of independent practice. There were three cohorts identified from electronic and scanned paper operation notes. The first cohort of standard anterior RARP (no hood sparing) included initial patients and any patient in the consecutive series who had completed 3 month FU after RARP. The second cohort was hemi‐hood‐sparing RARP again within the consecutive database of patients and lastly full‐hood‐sparing RARP. Early continence was defined by patients reporting being ‘dry’ and with 0 pad or 1 confidence/security pad. Data was collected in an Excel spreadsheet, and SPSS was used to assess distribution with non‐parametric data being analysed using a Mann Whitney U test and parametric data with an unpaired t‐test.ResultsWe identified 174 patients from March 2020 to February 2022 who were operated on. Full pathology and 6‐week follow‐up pad use data was available for all patients. At 12 months, some data for EPIC‐26 was not available (lack of response/clinic non‐attendance). The results demonstrate doubling in early continence to over 75% at 6‐week follow‐up with comparable positive margin rates. This difference was statistically significantly better in the dorsal venous complex RARP sparing group in comparison to standard RARP (p < 0.001).ConclusionAnterior hood‐sparing RARP with anterior reconstruction is a modification to the standard anterior RARP approach with a short learning curve which provides patients with better early and late continence without compromise to oncological outcomes.

Virtual surgical planning in microsurgical head and neck reconstruction: The Newcastle experience

Head and neck microvascular reconstruction is a complex but powerful tool following immediate cancer ablation or delayed sequalae after cancer treatment. Virtual surgical planning (VSP), using computer-aided design or computer-aided manufacturing has emerged as a potentially beneficial adjunct to head and neck reconstruction. The aim of this study was to assess the outcomes of VSP technology using the KLS Martin custom-made cutting guides and low-profile plates in head and neck microvascular reconstruction in our centre. A retrospective study was conducted at the regional head and neck centre in the UK from March 2017 until June 2023. A total of 127 patients were included. Among them, 77.8% of the patients underwent immediate reconstruction following cancer ablative procedure, with 22.2% being treated for osteoradionecrosis. Median flap ischaemia time was 130min (45-360min). Median number of osteotomies was 1 (0-3). Median operative time was 622min (302-962min). Procedural complications occurred in 16.2% of the patients. Total flap failure rate was 6.35%. This study found that patients who were operated on with palliative intent had significantly worse flap survival rates (p<0.033). The length of hospital stay was significantly impacted by longer operative time (p<0.002) and overall length of intensive therapy unit stay was significantly increased in diabetic and palliative patients. Three-dimensional planning software has become a standard of care within our centre, leading to shorter operative time, reliable and accurate reconstruction and a short learning curve for skill acquisition. Extensive surgery in palliative patients requires a robust consenting process in the context of a multi-disciplinary team discussion.

Arthroscopic Bone Block and Arthroscopic Latarjet for Anterior Shoulder Dislocation—Technical Note with Tricks and Tips for Conversion and Successful Surgery

Background: The treatment of patients affected by recurrent anterior shoulder instability has received more attention in the last ten years, focusing on the management of bone loss, which is crucial in predicting postoperative recurrence risk. Recently, various bone grafting techniques and different fixation methods have been developed to preserve native anatomy and reduce complications. Nowadays, glenoid bone reconstruction is usually carried out via the Latarjet procedure or free bone block technique. While the Latarjet procedure has traditionally been considered the best option, the bone block has been demonstrated to be a successful procedure. Even though the indication to perform a free bone block or a Latarjet procedure may be given preoperatively, in cases where the choice between the two procedures is unclear, the decision can be made intraoperatively, given the possibility to switch from one to another. This technical note aims to outline our techniques for the arthroscopic Latarjet procedure and the arthroscopic free bone block, as well as discuss the indications, benefits and downsides of each procedure. Technical tips and tricks are provided. Methods: A step-by-step thorough description of bone block and Latarjet procedures is provided, as well as a comparison of advantages and disadvantages of each technique and tips to avoid complications. Respective indications are discussed. Results: Both the procedures have benefits and downsides. The arthroscopic Latarjet procedure is the most effective in addressing anterior shoulder instability, but is more elaborate, has a shallow learning curve and can have a high complication rate. The bone block technique is an anatomic procedure with a shorter learning curve but has fewer indications. Conclusion: The Latarjet is currently considered the gold standard for glenoid bone grafting. The bone block technique can allegedly be seen as being “in the middle” of the soft tissue repair and Latarjet procedures. Many factors should be considered when choosing the right surgical technique, and treatment plans must be customized for each patient. More studies with long-term follow-up are needed to evaluate the efficacy of arthroscopic bone grafting procedures in various subtypes of patients based on bipolar bone loss assessment and individual risk factors.

Dorsal Preservation Rhinoplasty-the Perspective of "Preservers" Versus "Structural" Surgeons.

The objective of this study was to describe the surgeons who have incorporated dorsal preservation (DP) into their practice and their techniques. An anonymous form reviewed by the Evidence-Based Rhinoplasty Research Group board was shared on its Telegram group. The study population was divided into three groups based on their answers: "Preservers," "Mainly Structural," and "Structural exclusively." This study included the answers of 145 worldwide surgeons. DP was more common among plastic surgeons than otolaryngologists/facial plastic surgeons; DP techniques were mostly preferred by surgeons with 10-20 years of experience, while structural techniques were mostly preferred by surgeons with > 20 years of experience; 50.8% of the surgeons who prefer DP techniques use it in more than 90% of primaries; surface techniques (ST) have been more used, mainly by surgeons who prefer structural techniques (p < 0.001). ST were considered more stable (p < 0.001), more predictable (p < 0.001), and shorter learning curve (p < 0.001). Many surgeons using DP still perform structural rhinoplasty. The most cited concern was hump persistence/recurrence. DP rhinoplasty is gaining acceptance, and ST are favored for their perceived short learning curve, stability, and predictability. However, concerns about hump recurrence cause some to continue using structural methods alongside DP.

Learning curve for combined reconstruction of the anterolateral and anterior cruciate ligaments: a report of 108 cases with a single surgeon

BackgroundAnterior cruciate ligament (ACL) rupture is a common lesion among young sports players, for whom isolated surgical repair remains the gold standard. However, there is a high risk of re-rupture after ACL reconstruction. Recent results of ACL reconstruction combined with reconstruction of the anterolateral ligament (ALL) have shown a significant decrease in this risk. However, as with all new techniques, this requires a learning curve. HypothesisCombined reconstruction of the ACL and ALL would have a short learning curve, be reproducible and have no specific complications. Patients and methodsThis retrospective study included the first 108 patients who underwent combined ACL and ALL reconstruction by a single surgeon. The patients were divided into four similar sized chronological groups (groups 1–4). Tourniquet time and associated procedures were analysed. The results of the IKDC subjective knee evaluation, Lysholm, KOOS and SANE functional scores were collected postoperatively at 1-year through an online database. The position of the femoral tunnel was evaluated using the quadrant method of Bernard and Hertel. ResultsA significant improvement in the position of the femoral tunnel in the proximo-distal axis was observed between groups 1 and 4 (p < 0.01), as well as between groups 3 and 4 (p < 0.001). The Lysholm functional score was significantly higher in group 4 at 1-year (difference between groups 1 and 4 (+3.2 (1.4–5.1), p = 0.017)). The tourniquet time decreased significantly between the first group and groups 2, 3 and 4 (p < 0.002). DiscussionPrecise positioning of the femoral tunnel in the proximo-distal axis is important during combined reconstruction of the ACL and ALL. The combined technique had a rapid learning curve, was reproducible, and resulted in a rapid decrease in the tourniquet time. Level of evidenceIII; observational study.

Assessment of safety, efficacy and learning curve of intravascular lithotripsy in real world practice within a high volume calcium modification centre

Abstract Background There has been a rapid uptake in the use of intravascular lithotripsy (IVL) for calcium modification during percutaneous coronary intervention (PCI) due to its ease of use and excellent safety profile, particularly when compared to atherectomy devices. Purpose To review the adoption and safety of IVL in a high volume centre with established use of alternative calcium modification techniques Methods This was a retrospective analysis of all patients undergoing PCI from the introduction of IVL in January 2019 until December 2023. Patient demographics, comorbidity, procedure details and procedural complications were compared between IVL and non-IVL cases. Line charts were created to demonstrate the uptake and use of IVL per quarter compared with other established calcium modification strategies. A further line chart was created to compare the frequency of IVL use per quarter in more complex cases (left main intervention, ST elevation, treatment of in stent restenosis and in combination with rotational/orbital atherectomy). Results In the analysis timeframe there were 7,843 PCI cases performed, of which there were 301 IVL cases, 263 rotational/orbital atherectomy cases and 77 excimer laser atherectomy. IVL cases were older, more likely to have previous revascularisation (PCI (40.8% vs 57.1 % (p&amp;lt;0.001)) or bypass grafts 4.8% vs 8.0% (p=0.012)), diabetes mellitus (22.7% vs 33.6% (p&amp;lt;0.001)) and hypertension (45.4% vs 56.5% (p&amp;lt;0.001)). From a procedural perspective, treatment of left main and restenosis were more common with IVL compared with the rest of the cohort (7.0% vs 27.6% (p&amp;lt;0.001) and 8.3% vs 28.9% (p&amp;lt;0.001) respectively). IVL cases were more frequently guided by intracoronary imaging (intravascular ultrasound 35.9% vs 70.4% (p&amp;lt;0.001), optical coherence tomography 3.7% vs 18.9% (p&amp;lt;0.001)). Atherectomy was more frequent in IVL cases (excimer laser atherectomy 0.7% vs 7.3% (p&amp;lt;0.001) and rotational/orbital atherectomy 2.6% vs 22.9% (p&amp;lt;0.001)). Figure 1 shows the frequency of IVL use compared with other established calcium modification strategies per quarter and demonstrates the rapid and sustained uptake in IVL usage. Interestingly the use of other atherectomy techniques does not appear to have reduced. Figure 2 shows that IVL was quickly utilised in more complex calcification cases and again this has remained consistent since the introduction. Both figures demonstrate the short learning curve associated with IVL. Finally, there was no significant increase in perforation or slow/no reflow with IVL use (0.5% vs 0.7% (p=0.647) and 1.1% vs 1.3% (p=0.675) respectively) consistent with the published literature. There was an increase in documented coronary dissection with uncertain impact (3.4% vs 6.5% p=0.017). Conclusions IVL has become an essential tool within the calcium modification algorithm as a result of its ease of use, efficacy and excellent safety profile.Calcium modification per quarterFrequency of complex IVL cases

Invited Commentary: Transcarotid Artery Revascularization: Short Learning Curve but Low Procedural Volume Still Predicts Higher Morbidity.

Invited Commentary: Transcarotid Artery Revascularization: Short Learning Curve but Low Procedural Volume Still Predicts Higher Morbidity.

Trans-Pars Interarticularis Approach for Lumbar Interbody Fusion: An Efficient, Straightforward, and Minimally Invasive Surgery for Lumbar Spondylolisthesis and Stenosis.

Lumbar interbody fusion is a commonly applied surgical treatment for spondylolisthesis. For this procedure, various minimally invasive (MIS) approaches have been developed, including posterior lumbar interbody fusion, transforaminal lumbar interbody fusion (TLIF), oblique lumbar interbody fusion, and anterior lumbar interbody fusion. In this study, we characterized the features of an MIS trans-pars interarticularis lumbar interbody fusion (TPLIF) and compared its surgical outcomes with those of MIS-TLIF. This study included 89 and 44 patients who had undergone MIS-TPLIF and MIS-TLIF, respectively, between September 2016 and December 2022. The following clinical outcomes were analyzed: operative time, blood loss, and hospitalization duration. The average operative time, blood loss, and hospitalization duration for the MIS-TPLIF and MIS-TLIF groups were, respectively, 98.28 and 191.15 minutes, 41.97 and 101.85 mL, and 5.8 and 6.9 days. The MIS-TPLIF approach for lumbar spondylolisthesis or other degenerative diseases involves the use of the commonly available and cost-effective instrument Taylor retractor, thus enabling posterior lumbar interbody fusion to be performed with minimal invasion. This approach also confers the benefits of a short learning curve and an intuitive approach. Our results suggest that although MIS-TPLIF is noninferior to MIS-TLIF, it is easier to learn and perform than MIS-TLIF.

Ablation of Supraventricular Arrhythmias With as Low as Reasonably Achievable X-Ray exposure (AALARA): Results of Prospective, Observational, Multicenter, Multinational, Open-Label Registry Study on Real World Data Using Routine Ensite 3D Mapping During SVT Ablation.

The reduction of fluoroscopic exposure during catheter ablation of supraventricular arrhythmias is widely adopted by experienced electrophysiology physicians with a relatively short learning curve and is becoming the standard of care in many parts of the world. While observational studies in the United States and some parts of Western Europe have evaluated the minimal fluoroscopic approach, there are scarce real-world data for this technique and the generalizability of outcomes in other economic regions. The AALARA study is a prospective, observational, multicenter, and multinational open-label study. Patients were recruited from 13 countries across Central Eastern Europe, North and South Africa, the Middle East, and the CIS (Commonwealth of Independent States), with different levels of operator expertise using minimal fluoroscopic exposure techniques. Data on radiation exposure, procedural success, complications, recurrence, and quality of life changes were collected and analyzed. A total of 680 patients were enrolled and followed for 6 months. The majority were ablation naïve with the commonest arrhythmia ablated being typical AVNRT (58%) followed by Atrial Flutter (23%). Zero fluoroscopy exposure was observed in almost 90% of the cases. Fluoroscopy was most commonly used during the ablation phase of the procedure. We observed a high acute success rate (99%), a low complication rate (0.4%), and a 6-month recurrence rate of 3.8%. There was a significant improvement in the patient's symptoms and quality of life as measured by patient global assessment. The routine use of a 3D mapping system during right-sided ablation was associated with low radiation exposure and associated with high acute success rate, low complications, and recurrence rate along with significant improvement in quality of life. The data confirm the reproducibility of this approach in real-world settings across different healthcare systems, and operator experience supporting this approach to minimize radiation exposure without compromising efficacy and safety. NCT04716270.

A Comparative Study on the Application of Robotic Hair Restoration Technology Versus Traditional Follicular Unit Excision in Male Androgenetic Alopecia.

The robotic hair transplant technology, ARTAS, has a series of fine mechanical structure and an intelligent recognition system that allows it to independently select hair follicular units (FUs) and effectively harvest hair. After entering China in 2016, ARTAS has attracted the attention of hair transplant surgeons and hair loss patients given its advantages in a short learning curve and simple operation. To compare the efficacy and safety between the ARTAS system and follicular unit excision (FUE) in the treatment of male androgenetic alopecia (AGA) and to further promote the improvement and upgrading of ARTAS technology concerning hair transplantation. Thirteen Chinese male patients with Norwood-Hamilton II-IV AGA aged 25-35 years were enrolled in this study. The donor site of each patient was randomly divided into left and right regions, receiving ARTAS on one side and FUE on the other. Yield, transection, and discard rates of hair FUs from both sides were compared. Safety of the procedures in whole, as well as follow-up results were investigated and evaluated. The total yield rate on the ARTAS side was lower than on the FUE side (82.05% vs. 90.03%, p > 0.05); the total discard rate on the ARTAS side was higher than on the FUE side (10.71% vs. 5.46%, p < 0.05); the total transection rate on the ARTAS side was lower than on the FUE side (13.17% vs. 13.96%, p > 0.05). No significant difference was found in patient satisfaction (efficacy), and no side effects or complications were detected during or after all surgeries. The current iteration of Robotic hair transplant technology is effective and safe, and can be recommended for AGA hair transplantation surgery.

Medially Based “Abdominal Rotation Advancement Flap”: A Promising Technique for Mastectomy Defect Reconstruction in “High-Risk Patients” Awaiting Adjuvant Radiotherapy

Abstract Background Extensive postmastectomy defects and soft-tissue defects often require some additional flap cover of reconstruction after excision. The reconstruction aim in this group should be a diligent and easy closure with a quality skin cover, early recovery, and brief stay in hospital so that the patients can receive early postoperative radiotherapy/chemotherapy. Medially based abdominal transposition flap is a type C fasciocutaneous flap based on medial perforating vessels. We present our experience in significant postmastectomy defects, especially in high-risk morbid patients. Materials and Methods This is a retrospective study conducted by the department of plastic surgery, from an analysis of the breast cancer database maintained by our hospital from 2019 to 2023. A total of 826 breast cancer patients underwent surgery, of which 547 were locally advanced breast cancer (LABC) patients and 138 (32.5%) LABC patients needed flap cover for mastectomy defect. Medially based abdominal transposition flap was used in 56 of 138 (40.5%) LABC patients for defect closure, and 42 of the 56 patients were stage IIIB patients. Upfront surgery was primarily done in 20 patients and 36 patients underwent surgery after neoadjuvant chemotherapy. This analysis aimed to assess the operative duration, postoperative morbidity, hospital stay, and time taken to start adjuvant treatment by analyzing the medical records of patients who underwent this procedure. Results Fifty-six patients with breast cancer underwent surgical intervention, whereby 8 patients presented with tip and edge necrosis, and 3 patients were infected. The mean duration of operation was 58.852 minutes, and the average length of hospital stay was 5.39 days. It took 24.57 days for the patients to stabilize sufficiently for adjuvant therapy. The average age of the patients in the study was 48.73 years. Conclusion Our clinical experience has demonstrated that the medial abdominal transposition fasciocutaneous (MATF) flap represents a straightforward, reliable, and cost-effective method for managing extensive postmastectomy soft-tissue defects in a subset of patients with LABC. This group typically consists of high-risk and comorbid patients. The procedure holds considerable promise for developing countries with limited infrastructure and expertise, owing to its ease of execution and short learning curve. By its simplicity and affordability, the MATF flap offers a viable and sustainable solution for treating LABC-associated soft-tissue defects.

A modified double-incision technique to place tunneled central lines in children.

In children, there are two main techniques for placing a tunneled central venous catheter: single-incision (single puncture) and conventional (two punctures). Both have unique advantages and disadvantages. The modified single-stick technique combines the two aforementioned techniques to access the central venous system in an optimized way. This technique is feasible to perform particularly in young children and has a short learning curve for adult interventional radiologists.

Feasibility and safety of transarterial chemoembolization in patients with liver cancer via the distal radial approach: a single-center retrospective cohort study.

The femoral artery is the standard route for transarterial chemoembolization (TACE); however, it is negatively associated with the quality of life of patients, and carries an increased risk of deep vein thrombosis in the lower limbs. We employed the distal radial approach to TACE to assess its feasibility and safety. We conducted a retrospective study at the First Hospital of Jilin University from August 1, 2020 to October 31, 2023. To be eligible for inclusion in the study, the patients had to meet the following main inclusion criteria: (I) have undergone a preoperative imaging (abdominal computed tomography enhancement or magnetic resonance dynamic enhancement) examination, or have a pathologically confirmed diagnosis of primary liver cancer, and a Child-Pugh score of A or B; and (II) have undergone distal radial artery puncture. The primary endpoint of this study was the success rate of distal radial artery puncture. The secondary endpoints were complications and the duration of the puncture. Among the 343 patients with primary liver cancer (of whom 236 were male and 107 were female), a total of 1,315 distal radial artery punctures were attempted. The success rate was remarkably high at 95.13% (1,251/1,315), with only 64 cases requiring an alternative approach due to failed puncture. The average puncture duration was 20±7.43 minutes. No bleeding and hematoma, no arterial dissection and pseudoaneurysm formation were observed on ultrasound, and the radial pulse was palpable in all patients, highlighting the safety of the procedure. Further, no adverse events of vascular occlusion were observed among the 12 patients who received 6 or more punctures, indicating the sustainability of the distal radial artery access under the premise of adequate vascular protection. The development of this technique requires a learning curve of at least 50 cases to break through the learning baseline and be proficient in distal radial artery blind puncture. This may be the reason why many interventional physicians are reluctant to perform this procedure, adapting to the femoral approach with a shorter learning curve. The distal radial artery approach is feasible and safe in hepatic arterial chemoembolization, and should be widely promoted in TACE.

Safety, efficacy, and clinical outcomes of transconjunctival intrascleral fixation of an intraocular lens

BackgroundImplantation of intraocular lens in the capsular bag has become the standard of care in aphakic state. However, in the absence of capsular support, several techniques and intraocular lenses are available. Our study aims to report the safety, efficacy, and clinical outcomes of transconjunctival intrascleral intraocular lens fixation with Yamane’s double-needle technique and flanged haptics.MethodsProspective, observational study with some retrospective data collection. The study enrolled 13 patients (16 eyes) who underwent transconjunctival intrascleral fixation of an intraocular lens with Yamane’s technique between June 2017 and April 2019 at Dhahran Eye Specialist Hospital and King Fahd University Hospital. All patients underwent preoperative and postoperative comprehensive evaluation, including uncorrected and best-corrected vision, intraocular pressure, slit-lamp examination, dilated fundus examination, and ultrasound biomicroscopy. We excluded patients with visually significant coexistent pathology such as retinal diseases, glaucoma, follow-up less than three months, and combined surgery such as keratoplasty.ResultsThe mean preoperative uncorrected visual acuity was 1.50 logMAR, and it improved to 0.60 logMAR. The mean preoperative best-corrected visual acuity was 0.70 logMAR, and it improved to 0.40 logMAR. The median safety index was 2.0, and the median efficacy index was 1.58. The postoperative complications included iris capture by the intraocular lens in one eye (7.7%), haptic extrusion in one eye (7.7%), and transient cornea edema in one eye (7.7%). There were no detected reports during the follow-up period of postoperative retinal detachment, choroidal detachment, elevation of the intraocular pressure (> 25 mmHg), hypotony, hyphema, vitreous hemorrhage, or endophthalmitis.ConclusionsThe transconjunctival intrascleral fixation of an intraocular lens is safe and effective with a short learning curve and was not associated with significant intraoperative or postoperative complications.

Uniportal Video-Assisted Thoracoscopic Surgery for Minor Procedures.

Uniportal video-assisted thoracoscopic surgery (uVATS) is becoming popular for major lung resections, even for more complex procedures. The technique initially described for minor procedures seems more difficult to reproduce and has a longer learning curve. This review aims to describe the evolution from multiportal to uVATS and to explore its feasibility and reproducibility by identifying its drawbacks and limitations. Research from PubMed was obtained with the terms [uniportal] AND [surgery] OR [single-port] AND [thoracic surgery] OR [VATS]. Papers concerning pediatric cases and non-English papers were excluded. Individual case reports were also excluded. uVATS seems to be widely adopted and performed for minor procedures. The applicability of uVATS for different indications is discussed, even though practically all thoracic surgical interventions can be performed through a single incision. The transition from conventional three-port VATS to uVATS is described in this paper. An increasing number of thoracic surgeons worldwide have adopted this approach, even for major complex anatomical lung resections. Regarding the performance of minor thoracic interventions, we believe this technique is easily reproducible with a short learning curve because the instruments do not cross each other, and intraoperative movements remain intuitive. It is therefore a feasible, safe, and efficacious technique. For these reasons, we believe uVATS should be offered to all patients undergoing minor thoracoscopic procedures.

Usability testing of a novel interlocking three-dimensional miniplate for mandibular angle fractures.

We developed a novel interlocking three-dimensional (3D) miniplate design with an adjustable configuration. As this device is new, surgeons must become familiar with its application. This study evaluated the usability and learning curves associated with the novel interlocking 3D miniplate for mandibular fracture fixation. The study participants, nine plastic surgeons, were asked to apply an interlocking 3D miniplate and a standard miniplate to polyurethane mandible models. The participants had completed the Basic Craniomaxillofacial Osteosynthesis course during residency and had operated on craniomaxillofacial fractures within the past 5 years. They were instructed to place the interlocking 3D miniplate three times and the standard miniplate once. We assessed the time required for implant placement, the comfort level of the surgeons, and the biomechanical stability of the plates. Biomechanical testing was conducted by subjecting the mandible to forces ranging from 10 to 90 N and the displacement was measured. The results indicate increasing comfort with each attempt at placing the interlocking 3D miniplate, with a significant difference between the first and third attempts. Additionally, a reduction in application time was noted with repeated attempts, suggesting improved efficiency. Biomechanical tests showed comparable stability between the tested plates. Multiple attempts at applying the interlocking 3D miniplate resulted in increased comfort and reduced application time. These findings indicate that, despite its novelty, the interlocking 3D miniplate is relatively straightforward to apply and has a short learning curve. However, surgeons must have specific qualifications to ensure proper training and minimize errors during placement.

A Comparison of the First 60 Enucleation Cases Using a Thulium Fiber Laser without a Mentor to a Transurethral Resection of the Prostate (TURP) and Open Prostatectomy, and the Learning Curve.

Background and Objectives: In the surgical treatment of benign prostatic hyperplasia (BPH), laser enucleation of the prostate is recommended as an alternative to transurethral resection (TURP) and open prostatectomy (OP). The thulium fiber laser, with its superficial penetration depth, can offer a rapid learning process by causing less heat injury and capsule damage. This study compares the first 60 cases of an endourologist performing thulium fiber enucleation of the prostate (ThuFLEP) without a mentor to the results of OP and TURP performed by experienced surgeons. It also identifies the case number at which the operation time for ThuFLEP starts to plateau. Materials and Methods: Between 1 November 2021 and 1 November 2023, the initial 60 ThuFLEP cases of an endourologist with no prior enucleation experience were compared with TURP and OP operations performed by experienced surgeons. Since the first 60 ThuFLEP cases involved 80-120 cc prostates, TURP and OP operations within this size range performed during the same period were included in the study. The groups were assessed for age, preoperative and postoperative prostate volume, PSA levels, the IPSS, the IPSS Quality of Life (QoL), and maximum urinary flow (Qmax). The 60 consecutive ThuFLEP cases were divided into three groups of 20 (Groups 1, 2, and 3) and compared for operation time, IPSS, and Qmax. Results: The operation time for TURP was shorter than for ThuFLEP and OP (p < 0.001). There was no significant difference between ThuFLEP and OP in postoperative Qmax and IPSS, while TURP had lower values than the other two methods. For ThuFLEP, the operation time was longer in the first 20 cases but plateaued in groups 2 and 3 (p < 0.001). Postoperative Qmax and IPSS values showed no significant differences among the three ThuFLEP groups (p > 0.05). Conclusions: For large prostates, ThuFLEP provides better postoperative results than TURP and offers shorter catheterization and hospital stay times than OP. Its short learning curve makes it a preferable method for treating BPH compared to other laser techniques.

Learning curve for robot-assisted nipple-sparing mastectomy: A single institution experience

BackgroundRobot-assisted nipple sparing mastectomy (RANSM) is emerging because it offers hidden incisions and ergonomic movements. In this study, we report the learning curve and feasibility of RANSM. MethodsA retrospective study was conducted among women who underwent RANSM with immediate breast reconstruction from July 2019 to June 2022. All RANSM procedures were performed by a single surgeon. We divided all the cases into two phases: the early phase (cases 1 to 21) and the late phase (cases 22 to 46). The total operation time, breast operation time, docking time, and console time were analyzed, and the cumulative sum (CUSUM) method was used to evaluate the effects of case experience accumulation on the time required for RANSM. Postoperative complications were analyzed according to their Clavien-Dindo grade. ResultsOverall, 42 women underwent 46 RANSM procedures. In the early and late phases, the mean console times were 78.1 min and 60.1 min (p = 0.011), respectively. In learning curve analysis, 21 RANSM procedures were required to reduce the breast operation time. Two cases of Clavien-Dindo grade III postoperative complications occurred (4.3 %). One case was an implant removal caused by infection, and the other was partial nipple ischemia; both occurred in the early phase, with none in the late phase. ConclusionsThe breast operation time improved after the 21st RANSM procedure, and only two cases had Clavien-Dindo grade III or higher postoperative complications. RANSM is thus technically feasible and acceptable, with a short learning curve.