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Anastomotic time was associated with postoperative complications: a cumulative sum analysis of thoracoscopic repair of tracheoesophageal fistula in a single surgeon’s experience

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Abstract

Purpose

This study aimed to evaluate the learning curve of thoracoscopic repair of tracheoesophageal fistula (TEF) by a single surgeon using a cumulative sum (CUSUM) analysis.

Methods

Prospective clinical data of consecutive Gross type-C TEF repairs performed by a pediatric surgeon from 2010 to 2020 were recorded. CUSUM charts for anastomosis and operating times were generated. The learning curves were compared with the effect of accumulation based on case experience.

Results

For 33 consecutive cases, the mean operative and anastomosis times were 139 ± 39 min and 3137 ± 1110 s, respectively. Significant transitions beyond the learning phase for total operating and anastomosis times were observed at cases 13 and 17. Both the total operating time and anastomosis time were significantly faster in the proficiency improvement phase than in the initial learning phase. Postoperative complications significantly decreased after the initial anastomosis learning phase but not after the initial total operating learning phase.

Conclusions

Thoracoscopic repair of TEF is considered safe and feasible after 13 cases, where the surgeon can improve their proficiency with the total operation procedure, and 17 cases, which will enable the surgeon to achieve proficiency in anastomosis. Postoperative complications significantly decreased after gaining familiarity with the anastomosis procedure through the learning phase.

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References

  1. Rodgers BM, Talbert JL. Thoracoscopy for diagnosis of intrathoracic lesions in children. J Pediatr Surg. 1976;11:703–8.

    Article  CAS  PubMed  Google Scholar 

  2. Rothenberg SS. Thoracoscopic repair of tracheoesophageal fistula in newborns. J Pediatr Surg. 2002;37:869–72.

    Article  PubMed  Google Scholar 

  3. Karpelowsky J. Paediatric thoracoscopic surgery. Paediatr Respir Rev. 2012; 13:244–50; quiz 250–41.

  4. Khan N, Abboudi H, Khan MS, Dasgupta P, Ahmed K. Measuring the surgical “learning curve”: methods, variables and competency. BJU Int. 2014;113:504–8.

    Article  PubMed  Google Scholar 

  5. Biau DJ, Resche-Rigon M, Godiris-Petit G, Nizard RS, Porcher R. Quality control of surgical and interventional procedures: a review of the CUSUM. Qual Saf Health Care. 2007;16:203–7.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Steiner SH, Woodall WH. Debate: what is the best method to monitor surgical performance? BMC Surg. 2016;16:15.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cundy TP, Gattas NE, White AD, Najmaldin AS. Learning curve evaluation using cumulative summation analysis-a clinical example of pediatric robot-assisted laparoscopic pyeloplasty. J Pediatr Surg. 2015;50:1368–73.

    Article  PubMed  Google Scholar 

  8. Shirota C, Tanaka Y, Tainaka T, Sumida W, Yokota K, Makita S, et al. Therapeutic strategy for thoracoscopic repair of esophageal atresia and its outcome. Pediatr Surg Int. 2019;35:1071–6.

    Article  PubMed  Google Scholar 

  9. Novoa NM, Varela G. Monitoring surgical quality: the cumulative sum (CUSUM) approach. Mediastinum. 2020;4:4.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;24:205–13.

    Article  Google Scholar 

  11. Pinheiro PF, Simões e Silva AC, Pereira RM. Current knowledge on esophageal atresia. World J Gastroenterol. 2012; 18(28):3662–72.

  12. Comella A, Tan Tanny SP, Hutson JM, Omari TI, Teague WJ, Nataraja RM, King SK. Esophageal morbidity in patients following repair of esophageal atresia: a systematic review. J Pediatr Surg. 2021;56(9):1555–63.

    Article  PubMed  Google Scholar 

  13. Tambucci R, Isoldi S, Angelino G, Torroni F, Faraci S, Rea F, et al. Evaluation of gastroesophageal reflux disease 1 year after esophageal atresia repair: paradigms lost from a single snapshot? J Pediatr. 2021;228:155-63.e1.

    Article  PubMed  Google Scholar 

  14. Al-Qahtani AR, Almaramhi H. Minimal access surgery in neonates and infants. J Pediatr Surg. 2006;41:910–3.

    Article  PubMed  Google Scholar 

  15. Allal H, Kalfa N, Lopez M, Forgues D, Guibal MP, Raux O, et al. Benefits of the thoracoscopic approach for short- or long-gap esophageal atresia. J Laparoendosc Adv Surg Tech A. 2005;15:673–7.

    Article  PubMed  Google Scholar 

  16. Drevin G, Andersson B, Svensson JF. Thoracoscopy or thoracotomy for esophageal atresia: a systematic review and meta-analysis. Ann Surg. 2021;274:945–53.

    Article  PubMed  Google Scholar 

  17. Szavay PO, Zundel S, Blumenstock G, Kirschner HJ, Luithle T, Girisch M, et al. Perioperative outcome of patients with esophageal atresia and tracheo-esophageal fistula undergoing open versus thoracoscopic surgery. J Laparoendosc Adv Surg Tech A. 2011;21:439–43.

    Article  PubMed  Google Scholar 

  18. van der Zee DC, Tytgat SH, Zwaveling S, van Herwaarden MY, Vieira-Travassos D. Learning curve of thoracoscopic repair of esophageal atresia. World J Surg. 2012;36:2093–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lugo B, Malhotra A, Guner Y, Nguyen T, Ford H, Nguyen NX. Thoracoscopic versus open repair of tracheoesophageal fistula and esophageal atresia. J Laparoendosc Adv Surg Tech A. 2008;18:753–6.

    Article  PubMed  Google Scholar 

  20. Etchill EW, Giuliano KA, Boss EF, Rhee DS, Kunisaki SM. Association of operative approach with outcomes in neonates with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. 2021;56:2172–9.

    Article  PubMed  Google Scholar 

  21. Lee S, Lee SK, Seo JM. Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula: overcoming the learning curve. J Pediatr Surg. 2014;49:1570–2.

    Article  PubMed  Google Scholar 

  22. Kwak HY, Kim SH, Chae BJ, Song BJ, Jung SS, Bae JS. Learning curve for gasless endoscopic thyroidectomy using the trans-axillary approach: a CUSUM analysis of a single surgeon’s experience. Int J Surg. 2014;12:1273–7.

    Article  PubMed  Google Scholar 

  23. Wohl H. The CUSUM plot: its utility in the analysis of clinical data. N Engl J Med. 1977;296:1044–5.

    Article  CAS  PubMed  Google Scholar 

  24. Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM. Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc. 2011;25:855–60.

    Article  PubMed  Google Scholar 

  25. Kim W, Son J, Lee S, Seo JM. The learning curve for thoracoscopic repair of esophageal atresia with distal tracheoesophageal fistula: a cumulative sum analysis. J Pediatr Surg. 2020;55:2527–30.

    Article  PubMed  Google Scholar 

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Funding

This study was supported by JSPS KAKENHI (Grant Number: JP19120733).

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yaohui Guo, Takahisa Tainaka, Wataru Sumida, Satoshi Makita, Masamune Okamoto, Aitarou Takimoto, Akihiro Yasui, Shunya Takada, Yoichi Nakagawa, Daiki Kato, Takuya Maeda, Hiroo Uchida & Chiyoe Shirota

  2. Department of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Akinari Hinoki & Hizuru Amano

  3. Department of Saitama Prefectural Children’s Medical Center, Saitama, Japan

    Kyoichi Deie & Hiroshi Kawashima

Authors
  1. Yaohui Guo
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  2. Akinari Hinoki
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  3. Kyoichi Deie
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  4. Takahisa Tainaka
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  5. Wataru Sumida
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  6. Satoshi Makita
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  7. Masamune Okamoto
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  8. Aitarou Takimoto
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  11. Yoichi Nakagawa
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  12. Daiki Kato
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  13. Takuya Maeda
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  14. Hizuru Amano
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  15. Hiroshi Kawashima
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  16. Hiroo Uchida
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  17. Chiyoe Shirota
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Corresponding author

Correspondence to Hiroo Uchida.

Ethics declarations

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Ethical standards

All procedures performed in this study were per the ethical standards of the institutional and national research committees and the 1964 Declaration of Helsinki and its later amendments. Before the commencement of the study, all protocols were approved by the ethics review board of our institute (Approval number: 2022–0491). This study was approved by the Ethics Committee of our institute.

Research involving human participants

All procedures performed in this study were in accordance with the ethical standards of the Ethics Review Board at Nagoya University Graduate School of Medicine.

Informed consent

As this was a retrospective observational study and the data analyzed were anonymized, informed consent from the participants or their parents/guardians was obtained through an opt-out method on our hospital website in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan.

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Guo, Y., Hinoki, A., Deie, K. et al. Anastomotic time was associated with postoperative complications: a cumulative sum analysis of thoracoscopic repair of tracheoesophageal fistula in a single surgeon’s experience. Surg Today 53, 1363–1371 (2023). https://doi.org/10.1007/s00595-023-02687-9

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  • DOI: https://doi.org/10.1007/s00595-023-02687-9

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