Learning curve of 70 cases of endoscopic saphenous vein harvesting
Xu Can, Wang Kuo, Xu Zhenjun, Fan Fudong, Pan Jun, Zhou Qing, Wang Dongjin
Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
Abstract：Objective This study aimed to explore the characteristics of the learning curve of laparoscopic harvesting of the great saphenous vein in coronary artery bypass grafting (CABG). MethodA cross-sectional study was conducted. This study included a total of 70 patients with coronary artery disease who underwent CABG in the coronary group of the Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, from July 2019 to July 2020, including 55 and 15 men and women, aged 49-82 years, respectively. Patients were divided into a group of 10 based on the order in which they underwent the procedure, and there were seven groups, in the order of S1-S7 groups, to observe and compare the baseline data of the seven groups and obtain the saphenous vein length (L), time (T), number of injuries, and L/T ratio. The 70 patients were divided into pre- and post-inflection point groups based on the learning curve inflection point, and the baseline data as well as each of the above-mentioned indexes were compared between the two groups. Results No statistically significant difference was found in the baseline data of patients in the seven groups from S1 to S7 in terms of sex, age, diabetes mellitus, and hypertension (all P values >0.05). The saphenous vein acquisition time, saphenous vein injury number, and L/T ratio were statistically different (F=4.95, 3.85, 5.12, all P values<0.001). The S7 group had the shortest saphenous vein acquisition time, the least saphenous vein injury number and the highest L/T ratio. Meanwhile, the S1 group took the longest time to obtain the great saphenous vein, had the most damage to the great saphenous vein, and had the lowest L/T ratio, and the differences between groups were statistically significant . No statistically significant difference was observed in the length of the great saphenous vein obtained (F=0.69, P=0.056). Pearson correlation analysis showed that there was a positive correlation between the L/T ratio and the number of surgical cases (i.e., the number of great saphenous veins obtained by endoscopy) (r=0.79, P <0.001) and the L/T ratio was among the top 35 patients. The number of cases rapidly increased with the increase in the number of operations performed by the operator, and then the growth rate slowed down and entered a plateau. Therefore, the 35th case was identified as the inflection point of the learning curve for laparoscopic surgery to obtain the great saphenous vein. Group 70 cases were divided into two groups before and after the inflection point, with 35 cases in each group. The post-inflection point group shortened the time to acquire the great saphenous vein, decreased the number of great saphenous vein injuries, and increased the L/T ratio, and the differences were statistically significant (t=6.32, 8.08, 6.71, all P values <0.001) as compared with the pre-inflection point group; no significant difference was observed in the length of the great saphenous vein obtained by laparoscopy between the two groups (P=0.167). Conclusion With adequate training time and appropriate harvesting method, the endoscopic saphenous vein technique can significantly reduce the incidence of saphenous vein injury as well as shorten the procedure time.
徐灿, 王阔, 徐贞俊, 范阜东, 潘俊, 周庆, 王东进. 70例腔镜大隐静脉获取术的手术者学习曲线分析[J]. 中华解剖与临床杂志, 2023, 28(9): 593-597.
Xu Can, Wang Kuo, Xu Zhenjun, Fan Fudong, Pan Jun, Zhou Qing, Wang Dongjin. Learning curve of 70 cases of endoscopic saphenous vein harvesting. Chinese Journal of Anatomy and Clinics, 2023, 28(9): 593-597.
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2023, Vol. 28 
