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Impact of prior thoracoscopic experience on the learning curve of robotic McKeown esophagectomy: a multidimensional analysis

Authors
 Ming-Ju Hsieh  ;  Seong Yong Park  ;  Yun-Wen Wen  ;  Dae Joon Kim  ;  Chien-Hung Chiu  ;  Yin-Kai Chao 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.36(8) : 5635-5643, 2022-08 
Journal Title
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
ISSN
 0930-2794 
Issue Date
2022-08
MeSH
Esophageal Neoplasms* / surgery ; Esophagectomy / methods ; Humans ; Learning Curve ; Lymph Node Excision / methods ; Recurrent Laryngeal Nerve / pathology ; Retrospective Studies ; Robotic Surgical Procedures* / methods ; Vocal Cord Paralysis* / etiology
Keywords
Learning curve ; Recurrent laryngeal nerve palsy ; Robotic esophagectomy ; Thoracoscopic esophagectomy ; Upper mediastinal lymph node dissection
Abstract
Purpose: Left upper mediastinal lymph node dissection (UMLND)-a technically demanding step of McKeown esophagectomy-is frequently complicated by recurrent laryngeal nerve (RLN) palsy. Under the hypothesis that robotic esophagectomy (RE) could increase the safety and feasibility of UMLND, we retrospectively investigated the degree to which a pre-existing experience in video-assisted thoracoscopic esophagectomy (VATE) may affect the learning curves of this critical part of RE.

Methods: Surgeon A had previously performed > 150 VATE procedures before transitioning to RE. While surgeon B had previously assisted to 50 RE, his pre-existing VATE experience consisted of less than five procedures. A total of 103 and 76 McKeown RE procedures were performed by surgeons A and B, respectively. The learning curve of left UMLND for each surgeon was examined using the cumulative sum method.

Results: The inflection point of RLN palsy for surgeon A occurred at patient 31. While the nerve palsy rate decreased from 32.3 to 4.2% (p < 0.001), the number of nodes harvested during left UMLND did not appreciably change. Surgeon B showed a bimodal learning curve for RLN palsy with primary and secondary inflection points at patients 15 and 49, respectively. The RLN palsy rate initially decreased from 66.7% (patients 1-15) to 14.7% (patients 16-49), followed by an additional decline to 3.7% (patients 50-76). However, the number of nodes harvested during left UMLND showed a downtrend which was paralleled by decreasing rates of RLN palsy. These results indicate that surgeon B has not yet reached an ideal balance between an extensive UMLND and nerve protection.

Conclusion: The pre-existing VATE experience seems to affect the learning curves of left UMLND during RE.
Full Text
https://link.springer.com/article/10.1007/s00464-022-09050-y
DOI
10.1007/s00464-022-09050-y
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dae Joon(김대준)
Park, Seong Yong(박성용) ORCID logo https://orcid.org/0000-0002-5180-3853
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/191762
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