描述机器人辅助支气管镜检查的学习曲线：分析高流量学术中心的技能掌握情况。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery Pub Date : 2025-01-01 DOI:10.1016/j.jtcvs.2024.06.018

Matthew J. Bott MD , Nicolas Toumbacaris MSPH , Kay See Tan PhD , Bryan C. Husta MD , Benjamin D. Medina MD , Prasad S. Adusumilli MD , Jason A. Beattie MD , Robert P. Lee MD , Bernard J. Park MD , Joseph Dycoco BS , David R. Jones MD , Mohit Chawla MD , Gaetano Rocco MD , Or Kalchiem-Dekel MD

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引用次数: 0

摘要

目的：形状传感机器人辅助支气管镜（ssRAB）是一种新兴的肺部病变取样技术。我们试图描述一个学术中心的ssRAB学习曲线：方法：我们对一家医疗机构的 9 名手术医师所做的 ssRAB 手术进行了分析。对每位操作者的前 50 个病例的诊断取样和手术时间进行了累积总和分析，可接受的产量阈值设定为 73%：研究期间，442 名患者接受了 551 个病灶的取样。每位操作者取样 61 个病灶（IQR，60-63）。病灶大小为 1.90 厘米（IQR，1.33-2.80）。单靶点病例的中位手术时间从最初 10 例的 62 分钟降至第 40 例之后的 39 分钟（PConclusions：在 ssRAB 中技能的掌握是多变的。大约一半的手术者在 25 例病变后就能熟练掌握这项技术。在最初的学习阶段之后，操作者会越来越多地针对具有更具挑战性特征的病变进行操作。总之，这些研究结果可以为认证和能力标准提供参考，并为新用户提供随着时间推移的相关性能预期。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Characterizing a learning curve for robotic-assisted bronchoscopy: Analysis of skills acquisition in a high-volume academic center

Objective

Shape-sensing robotic-assisted bronchoscopy is an emerging technology for the sampling of pulmonary lesions. We seek to characterize the shape-sensing robotic-assisted bronchoscopy learning curve at an academic center.

Methods

Shape-sensing robotic-assisted bronchoscopy procedures performed by 9 proceduralists at a single institution were analyzed. Cumulative sum analyses were performed to examine diagnostic sampling and procedure time over each operator’s first 50 cases, with the acceptable yield threshold set to 73%.

Results

During the study period, 442 patients underwent sampling of 551 lesions. Each operator sampled 61 lesions (interquartile range, 60-63 lesions). Lesion size was 1.90 cm (interquartile range, 1.33-2.80 cm). The median procedure time for single-target cases decreased from 62 minutes during the first 10 cases to 39 minutes after case 40 (P < .001). The overall diagnostic yield was 72% (range, 58%-83%). Six of 9 operators achieved proficiency over the study period. An aggregated cumulative sum analysis of those who achieved competency demonstrated a steep improvement between lesions 1 and 21 and crossing of the competency threshold by lesion 25. Temporal analysis of yield-related lesion characteristics demonstrated that at approximately lesion 20, more challenging lesions were increasingly targeted, as evidenced by smaller target size, higher rates of unfavorable radial endobronchial ultrasound views, and a negative bronchus sign.

Conclusions

Skills acquisition in shape-sensing robotic-assisted bronchoscopy is variable. Approximately half of proceduralists become facile with the technology within 25 lesions. After the initial learning phase, operators increasingly target lesions with more challenging features. Overall, these findings can inform certification and competency standards and provide new users with expectations related to performance over time.

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来源期刊

Journal of Thoracic and Cardiovascular Surgery 医学-呼吸系统

CiteScore

11.20

自引率

10.00%

发文量

1079

审稿时长

68 days

期刊介绍： The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.