Yao Qiu, Jiang Huizhong, Niu Hui, Hu Guangmo, Liu Xiaolong, Xue Boxin
Department of Urology, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou, 215000, Jiangsu, China.
Department of Operating Room, The Second Affiliated Hospital of Soochow University, Jiangsu, China.
BMC Surg. 2024 Feb 19;24(1):65. doi: 10.1186/s12893-024-02355-w.
As a relatively new surgical technique, the learning curve of en bloc resection of bladder tumor (ERBT) in ex vivo models remains unaddressed. This study aimed to explore the learning curve of ERBT in an ex vivo porcine model.
In this prospective study, eight endoscopists without prior experience in ERBT were divided into two groups: junior endoscopists, with less than 100 transurethral resection of bladder tumor (TURBT) procedure experience, and senior endoscopists, with at least 100 TURBT procedure experience. Each endoscopist performed 30 ERBT procedures on artificial lesions in an ex vivo porcine bladder model. The procedure time, perforation, en bloc resection status, and absence of detrusor muscle (DM) were recorded. The inflection points were identified using cumulative sum (CUSUM) analysis. Procedure results were compared between the two phases and two groups.
In all, 240 artificial lesions were successfully resected using ERBT. The CUSUM regression line indicated the inflection point at the 16th procedure for the junior endoscopists and at the 13th procedure for the senior endoscopists. In both groups, the procedure time, perforation, piecemeal resection, and DM absence rates were significantly lower in the consolidation phase than in the initial phase. The procedure time for the senior endoscopists was lower than for the junior endoscopists in both phases.
ERBT performance improved significantly after reaching the inflection point of the learning curve in the ex vivo model. We recommend a minimum of 16 ERBT procedures in ex vivo models for urologists with less than 100 TURBT experience and a minimum of 13 procedures for those with at least 100 TURBT experience before advancing to live animal training or supervised clinical practice.
作为一种相对较新的外科技术，膀胱肿瘤整块切除术（ERBT）在体外模型中的学习曲线尚未得到研究。本研究旨在探讨ERBT在体外猪模型中的学习曲线。
在这项前瞻性研究中，8名此前无ERBT经验的内镜医师被分为两组：经验不足100例经尿道膀胱肿瘤切除术（TURBT）的初级内镜医师和经验至少100例TURBT的高级内镜医师。每位内镜医师在体外猪膀胱模型中的人工病变上进行30例ERBT手术。记录手术时间、穿孔情况、整块切除状态以及逼尿肌缺失情况。使用累积和（CUSUM）分析确定拐点。比较两个阶段和两组之间的手术结果。
总共使用ERBT成功切除了240个人工病变。CUSUM回归线显示，初级内镜医师在第16例手术时出现拐点，高级内镜医师在第13例手术时出现拐点。在两组中，巩固阶段的手术时间、穿孔情况、碎块切除情况和逼尿肌缺失率均显著低于初始阶段。在两个阶段，高级内镜医师的手术时间均低于初级内镜医师。
在体外模型中达到学习曲线的拐点后，ERBT的操作有显著改善。我们建议，对于TURBT经验不足100例的泌尿外科医师，在体外模型中至少进行16例ERBT手术；对于TURBT经验至少100例的医师，在进入活体动物训练或临床实践指导之前，至少进行13例手术。
