Evaluating the learning curve for flexible ureteroscopic thulium fiber laser lithotripsy using CUSUM analysis.

IF 10.1 2区 医学 Q1 SURGERY International journal of surgery Pub Date : 2025-03-01 DOI:10.1097/JS9.0000000000002246
Zhilong Li, Shaojie Wu, Xiaoyu Tang, Yongwen Luo, Du Wang, Tongzu Liu, Sheng Li, Xinghuan Wang
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Abstract

Objectives: Effective training methods and learning curve (LC) assessment are crucial for more difficult endoscopic procedures. The present study sought to assess the LC of flexible ureteroscopes (fURS) for thulium fiber laser (TFL) lithotripsy and determine the effectiveness of using a porcine kidney model in training modality, to inform future training.

Methods: Postgraduate medical students without experience in ureteroscopy were recruited, and surgical data were collected from 10 consecutive flexible ureteroscopic lithotripsy (fURL) procedures performed on our homemade porcine kidney training model. Cumulative sum (CUSUM) analysis and pooled mean CUSUM curves were applied to determine the LC turning points (TPs), and pre-LC and post-LC data were compared with that of an experienced attending physician.

Results: Data from 110 surgeries were included in the analysis. The mean number of surgical units to overcome the LC for the duration of fURS TFL lithotripsy was 4. The operation time, number of tissue damage, and number of central visual shifts were significantly lower in students after the TP than before. No statistically significant difference in operation time was found between the students after the LC (817.50 [703.75-964.75]) and the surgeon group (732.50 [51.00-822.25]).

Conclusion: Overcoming the LC of fURS TFL lithotripsy requires four surgeries, and the developed ex vivo porcine kidney is a conveniently accessible and effective clinical training model.

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应用CUSUM分析评价输尿管软镜下铥纤维激光碎石的学习曲线。
目的:有效的培训方法和学习曲线(LC)评估对更困难的内镜手术至关重要。本研究旨在评估输尿管柔性镜用于铥光纤激光(TFL)碎石术的LC,并确定在训练模式中使用猪肾模型的有效性,为未来的训练提供信息。方法:招募没有输尿管镜检查经验的医学研究生,收集自制猪肾训练模型连续10例输尿管镜(fURS)碎石手术资料。应用累积和(CUSUM)分析和汇总平均CUSUM曲线来确定LC转折点(TPs),并将LC前和LC后的数据与经验丰富的主治医生的数据进行比较。结果:110例手术资料纳入分析。在fURS TFL碎石术期间克服LC的平均手术单位数为4。手术时间、组织损伤数、中心视觉移位数均明显低于手术前。术后学生组(817.50[703.75-964.75])与手术组(732.50[51.00-822.25])手术时间差异无统计学意义。结论:克服fURS TFL碎石术中的LC需要4次手术,体外培养的猪肾是一种方便、有效的临床训练模式。
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来源期刊
CiteScore
17.70
自引率
3.30%
发文量
0
审稿时长
6-12 weeks
期刊介绍: The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.
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