Department of Paediatric Otolaryngology, Starship Children's Health, Private Bag 92024, Auckland, 1142, New Zealand.
Department of Paediatric Otolaryngology, Starship Children's Health, Private Bag 92024, Auckland, 1142, New Zealand.
Int J Pediatr Otorhinolaryngol. 2022 Jul;158:111155. doi: 10.1016/j.ijporl.2022.111155. Epub 2022 May 2.
To evaluate the learning curve of BiZact™ tonsillectomy amongst trainees and fellows as a further technical skill.
Prospective audit of consecutive BiZact™ tonsillectomies undertaken by a trainee and fellow at Starship Children's Hospital. Primary outcomes measured were operative time from gag open to gag closed, readmission and post tonsillectomy bleed rates. Secondary outcomes included need for bipolar rescue dissection, bipolar haemostasis including site and side, tonsil size (Brodsky grade 1-4) and depth (shallow or deep). Operative time was plotted against number of procedures performed and moving averages was used to investigate the learning curve. Generalised linear model was applied to examine the association between operation time and tonsil depth.
Mean operative time for the trainee and fellow was similar (07 min 34 s versus 07min and 37 s). We observed a trend of decreased operative time over number of procedures performed by the trainee but the learning curve was short. The fellow's initial time was lower than the trainee's and remained similar over time. No bipolar rescue dissection was required. Additional bipolar haemostasis was required 95% of the time, but the majority involved the superior pole only (87.5%, p = 0.0001). The overall operative time for shallow tonsils was shorter than for deep tonsils (06 min 31 s versus 08 min 09 s, p = 0.0066). A learning curve was evident for both shallow and deep tonsils for both surgeons combined but was steeper for deep. There were no primary bleeds and the secondary haemorrhage rate was 5.8% (3/51 cases) with no returns to theatre.
This is the first study to investigate the BiZact™ tonsillectomy learning curve. BiZact™ tonsillectomy is safe and easy to learn. We observed a clear trend of shallow tonsils being quicker to remove than deep tonsils using this technique. The secondary bleed rate of 5.8% is comparable to the previously published Starship rate of 4.7% for all tonsillectomies performed over a 10 year period. Moving averages is a useful method to assess operative learning curves during training and beyond.
评估 BiZact™ 扁桃体切除术作为一项额外技术技能在学员和研究员中的学习曲线。
对 Starship 儿童医院的一名学员和研究员连续进行的 BiZact™ 扁桃体切除术进行前瞻性审核。主要测量结果是从张口到闭口的手术时间、再入院和扁桃体切除术后出血率。次要结果包括需要双极救援解剖、双极止血（包括部位和侧面）、扁桃体大小（Brodsky 分级 1-4）和深度（浅或深）。将手术时间与手术次数进行绘图，并使用移动平均值来研究学习曲线。应用广义线性模型来检验手术时间与扁桃体深度之间的关联。
学员和研究员的平均手术时间相似（07 分钟 34 秒与 07 分钟和 37 秒）。我们观察到学员的手术时间随着手术次数的增加而减少，但学习曲线很短。研究员的初始时间低于学员，但随着时间的推移保持相似。不需要双极救援解剖。需要额外的双极止血的时间为 95%，但大多数只涉及上极（87.5%，p=0.0001）。浅层扁桃体的总手术时间短于深层扁桃体（06 分钟 31 秒与 08 分钟 09 秒，p=0.0066）。对于两位外科医生来说，浅层和深层扁桃体都有明显的学习曲线，但深层的学习曲线更为陡峭。没有原发性出血，继发性出血率为 5.8%（3/51 例），无返回手术室。
这是第一项研究 BiZact™ 扁桃体切除术学习曲线的研究。BiZact™ 扁桃体切除术是安全且易于学习的。我们观察到使用这种技术，浅层扁桃体比深层扁桃体切除更快。5.8%的二次出血率与之前发表的 Starship 在 10 年期间进行的所有扁桃体切除术的 4.7%的出血率相当。移动平均值是评估培训期间和之后手术学习曲线的有用方法。
