No abstract available.
Colonoscopy* ; Learning Curve* ; Learning* ; Polyps*

No abstract available.
Gastrectomy* ; Learning Curve* ; Learning* ; Stomach Neoplasms*

PURPOSE: In the present study, we evaluated the learning curve of strabismus surgery performed by a single surgeon. METHODS: We reviewed the data of 62 patients with exodeviation who underwent strabismus surgery and were followed up for at least 3 months between March 2011 and November 2014. Patients were divided into 3 groups classified chronologically and the success rate in each group was investigated. Additionally, the results of exotropia surgery were analyzed using cumulative sum (CUSUM) analysis. We compared 5 m distal angle deviation preoperatively and 3 months after strabismus surgery. RESULTS: The overall surgical success rate of 62 patients was 72.6% (45/62). Success rates were 70% (14/20) in the first group, 71.4% (15/21) in the second group and 76.2% (16/21) in the third group. CUSUM analysis indicated that a surgeon's performance begins to improve at attempt number 11 and cumulative failure chart suggested the surgeon had achieved acceptable level of performance after 44 surgeries. CONCLUSIONS: A novice strabismus surgeon showed performance improvement after 11 cases and achieved acceptable level of performance after 44 strabismus surgeries. Although additional statistical data using more cases is needed, we suggest surgeons should perform at least 50 strabismus surgeries to ensure a high success rate.
Exotropia ; Humans ; Learning Curve* ; Strabismus*

PURPOSE: Totally extraperitoneal (TEP) hernia repair has gained in popularity in the past two decades. Despite the advantages TEP hernia repair, the approach is hindered by the relatively long learning curve of the surgery. We tried to estimate the necessary number of repetitions of TEP hernia repair in the learning curve using logarithmic and exponential function models. METHODS: We performed a retrospective review of all patients who underwent TEP hernia repair by a single surgeon consecutively at a single center. We calculated how many operations were needed to achieve a reduction in the expected operating time to mean operating time using logarithmic and exponential function models. RESULTS: In the 91 patients, the logarithmic function model predicted that 37 cases were needed to overcome the learning curve for TEP hernia repair while the exponential model predicted that 39 cases were needed. CONCLUSION: According to this study, at least 37 to 39 cases are needed in the overcome learning curve of TEP hernia repair. Further studies are needed to optimize surgical education and maximize quality.
Education ; Herniorrhaphy* ; Humans ; Learning Curve* ; Learning* ; Likelihood Functions ; Retrospective Studies

OBJECTIVE: To evaluate the effectiveness and feasibility of laparoscopic myomectomy compared to open myomectomy METHODS: A retrospective study of 85 cases of myomectomy was performed. Twenty six cases of open myomectomy (group I) and 59 cases of laparoscopic myomectomy (group II) were done by one main surgeon from 1996 to 2002 in the department of OBGYN at Moonhwa Hospital. Group II was divided into two subgroups, group IIA and group IIB. Group IIA included 17 cases of laparoscopic myomectomy done from 1996 to 1998 during learning period. Group IIB included 42 cases of laparoscopic myomectomy performed from 1999 to 2002 after learning period. RESULTS: There were no significant differences in age, parity, the number of myoma, and the size of myoma between groups I and II. The intensity of postoperative pain and febrile morbidity were significantly lower in group II than in group I (P<0.05). Mean operation time was significantly shorter in group I than in group II. However, after completing the learning curve, no significant difference was found in the operation time between group I and group IIB. Blood loss was significantly decreased in group II compared to group I (P<0.05). CONCLUSION: The learning curve for lasparoscopic myomectomy needed 17 cases and laparoscopic myomectomy could be an excellent minimally invasive method as an alternative of open myomectomy after learning curve.
Female ; Learning Curve* ; Learning* ; Myoma ; Pain, Postoperative ; Parity ; Retrospective Studies

STUDY DESIGN: A retrospective study OBJECTIVES: To try and find the best surgical technique by analyzing the real-time video taken during a percutaneous endoscopic interlaminar lumbar discectomy. SUMMARY OF LITERATURE REVIEW: A percutaneous endoscopic lumbar discectomy, using an interlaminar approach, has superior aspects, such as anatomical similarity with that of open spinal surgery, and applicability regardless of the herniated level. However, the technical difficulty can be an obstacle to shortening of the learning-curve. MATERIALS AND METHODS: Between January 2005 and January 2006, 56 patients who were underwent an operation at our hospital, due to single level (L4-5 or L5-S1) herniated lumbar disc disease, by one surgeon, and were selected for this study. The procedure was divided by the approach; either ligament flavum resection, partial removal of the lamina or root identification and discectomy. By analyzing the real-time video taken during the operation, as well as checking the time taken for each procedure, the factors influencing the prolongation of surgery time can be sought, and efforts made to shorten the operation time. RESULTS: The mean operation time was 65 minutes (28 minutes~127 minutes). The mean operation times in patients either requiring or not requiring partial removal of the lamina were 84 minutes (45 minutes~127 minutes) and 45 minutes (28 minutes~91 minutes), respectively, and also showed a statistically significant correlation (p=0.023). The mean operation times for the first and last 10 cases were 107 and 48 minutes, respectively. 3 cases needed revision open surgery due to failed symptom resolution. The procedures affecting a prolonged operation time were partial removal the lamina and ligament flavum resection. The time required for ligament flavum resection plateaued after 20 cases, and that for partial removal of the lamina reached plateau after 19 cases. CONCLUSIONS: By overcoming such technical problems, shortening of the learning-curve for a percutaneous endoscopic interlaminar lumbar discectomy was possible.
Diskectomy* ; Humans ; Learning Curve* ; Learning* ; Ligaments ; Retrospective Studies

PURPOSE: Most stomach surgeons have been educated sufficiently in conventional open distal gastrectomy (ODG) but insufficiently in laparoscopy-assisted distal gastrectomy (LADG). We compared learning curves and clinical outcomes between ODG and LADG by a single surgeon who had sufficient education of ODG and insufficient education of LADG. MATERIALS AND METHODS: ODG (90 patients, January through September, 2004) and LADG groups (90 patients, June 2006 to June 2007) were compared. The learning curve was assessed with the mean number of retrieved lymph nodes, operation time, and postoperative morbidity/mortality. RESULTS: Mean operation time was 168.3 minutes for ODG and 183.6 minutes for LADG. The mean number of retrieved lymph nodes was 37.9. Up to about the 20th to 25th cases, the slope decrease in the learning curve for LADG was more apparent than for ODG, although they both reached plateaus after the 50th cases. The mean number of retrieved lymph nodes reached the overall mean after the 30th and 40th cases for ODG and LADG, respectively. For ODG, complications were evenly distributed throughout the subgroups, whereas for LADG, complications occurred in 10 (33.3%) of the first 30 cases. CONCLUSIONS: Compared with conventional ODG, LADG is feasible, in particular for a surgeon who has had much experience with conventional ODG, although LADG required more operative time, slightly more time to get adequately retrieved lymph nodes and more complications. However, there were more minor problems in the first 30 LADG than ODG cases. The unfavorable results for LADG can be overcome easily through an adequate training program for LADG.
Gastrectomy ; Humans ; Learning ; Learning Curve ; Lymph Nodes ; Operative Time ; Stomach

PURPOSE: Most stomach surgeons have been educated sufficiently in conventional open distal gastrectomy (ODG) but insufficiently in laparoscopy-assisted distal gastrectomy (LADG). We compared learning curves and clinical outcomes between ODG and LADG by a single surgeon who had sufficient education of ODG and insufficient education of LADG. MATERIALS AND METHODS: ODG (90 patients, January through September, 2004) and LADG groups (90 patients, June 2006 to June 2007) were compared. The learning curve was assessed with the mean number of retrieved lymph nodes, operation time, and postoperative morbidity/mortality. RESULTS: Mean operation time was 168.3 minutes for ODG and 183.6 minutes for LADG. The mean number of retrieved lymph nodes was 37.9. Up to about the 20th to 25th cases, the slope decrease in the learning curve for LADG was more apparent than for ODG, although they both reached plateaus after the 50th cases. The mean number of retrieved lymph nodes reached the overall mean after the 30th and 40th cases for ODG and LADG, respectively. For ODG, complications were evenly distributed throughout the subgroups, whereas for LADG, complications occurred in 10 (33.3%) of the first 30 cases. CONCLUSIONS: Compared with conventional ODG, LADG is feasible, in particular for a surgeon who has had much experience with conventional ODG, although LADG required more operative time, slightly more time to get adequately retrieved lymph nodes and more complications. However, there were more minor problems in the first 30 LADG than ODG cases. The unfavorable results for LADG can be overcome easily through an adequate training program for LADG.
Gastrectomy ; Humans ; Learning ; Learning Curve ; Lymph Nodes ; Operative Time ; Stomach

OBJECTIVE: Total laparoscopic hysterectomy (TLH) is becoming more commonly used as an alternative to traditional abdominal hysterectomy and Analyzing the turning point of a learning curve can be useful in planning training programs. This study was to define the average turning point of a learning curve of TLH by comparing three separate gynecologists in one institute. METHODS: Retrospective analysis of the first 140 consecutive cases of TLH performed by three separate gynecologists A, B, and C. Patients of each gynecologist were divided into 7 equal groups of 20 operations classed chronologically. Patient's age, uterus weight, operation time and pre-post operative hemoglobin difference of the three gynecologists were compared. Operation time and pre-post operative hemoglobin difference were evaluated to build learning curves for each gynecologist. RESULTS: Learning curve built by operation time showed turning point after 80~100 cases in all three gynecologists. Learning curve built by pre-post operative hemoglobin difference did not show a decreasing pattern. There were no statistical differences in patient's age and pre-post operative hemoglobin difference between the three gynecologists. However, mean uterine weight of gynecologist C was significantly lighter than that of gynecologist A and B. Operation time was significantly longer in cases by gynecologist C than in cases by A and B. CONCLUSION: At least 80~100 cases of experience in TLH is needed for a gynecologist to reach the turning point of the learning curve. This result can be used as a guide to the training program of TLH.
Hemoglobins ; Humans ; Hysterectomy ; Learning ; Learning Curve ; Retrospective Studies ; Uterus

OBJECTIVETo investigate the learning curve of cochlear implantation and its guiding significance for clinical surgery.

METHODSA retrospective analysis of the clinical data of two otologists in early cochlear implant surgeries, including 98 cases of Dr. A and 54 cases of Dr. B.Statistics of the two doctors incidence of complications and operating time. Operation time as index were drawing a, b two groups of cases of scatter plot, the oscillating sine curve model Y = sin(X)-P/2 and logarithmic curve model Y = b1ln(X)+b0 curve fit were analyzed. Then, extract the early 90 cases of surgery by Dr. A which was divided into a, b, c three groups with 30 cases a group. The operating time and complications were further compared and analyzed(SPSS 16.0).

RESULTSFrom the operation sequence,A and B physicians, early operation cases cost more operating time, and more complications.Learning curve before and after about 30 cases appeared inflection point, showing a rapid decline in period (learning phase) and slow decline period (consolidation phase) in two stages.Group contrast to Dr. A's early 90 consecutive cases, the operating time of Phase b and Phase c decreased significantly than Phase a (P(a-b) < 0.01, P(a-c) < 0.01), while there was no significant difference between group Phase b and Phase c (P(b-c) = 0.68), the complication rate of Phase b and Phase c decreased significantly than Phase a (P(a-b) < 0.01, P(a-c) < 0.01), while there was no significant difference between group Phase b and Phase c (P(b-c) = 0.15).

CONCLUSIONSOur department of cochlear implantation followed the learning curve rule. The minimum number of cases that should accumulate in the learning phase needs about 30 cases.