[Evaluation of experience acquisition in video-assisted hemithyroidectomy]. / Sposoby otsenki priobreteniya opyta pri osvoenii videoassistirovannykh gemitireoidektomii.

OBJECTIVE: To determine validity and adequacy of the assessment of experience acquisition in video-assisted hemithyroidectomy, to compare surgical outcomes at the learning stage and in delayed period. MATERIAL AND METHODS: Experience acquisition was studied via assessment of the duration of video-assisted hemithyroidectomy in 67 patients who were operated by the same surgeon. Time of surgery was analyzed through between-group comparison of surgical outcomes. These groups were defined arbitrarily, in exponential fashion, using the logarithm method and moving average. Risks of failure regarding duration of surgery and postoperative complications were investigated using CUSUM analysis. RESULTS: Minimum period of experience accumulation in video-assisted hemithyroidectomy (26 procedures) was determined using logarithmic analysis, maximum period (66 interventions) - using CUSUM analysis. Other approaches also showed sharp nature of the learning curve.CUSUM analysis of failures at the learning stage showed 2-fold decrease of their probability after 66 operations. However, even experience acquisitiondoes not exclude risk of failures in hemithyroidectomy. CONCLUSION: Arbitrary division of the cohort of patients seems to be unreasonable because clear number of operations necessary to achieve sustainable results does not follow it.Mathematical methods adequately reflect experience accumulation and allow determining the required number of interventions for stable results and minimum complication rate.

[Experience of reconstructive laparoscopic procedures in patients with terminal colostomy]. / Opyt osvoeniia vosstanovitel'nykh operatsii laparoskopicheski-assistirovannym sposobom u bol'nykh s kontsevoi kolostomoi.

AIM: To analyze the ways and terms of training for laparoscopy-assisted reconstruction operations via learning curves analysis and to compare the outcomes obtained both during training for technique and after that. MATERIAL AND METHODS: There were 93 reconstructive laparoscopic procedures in 58 (62.36%) patients with terminal colostomy. All patients were operated by the same surgeon. Learning curves have been created and analyzed. RESULTS: Analysis showed that all surgical features are achieved by the 30th intervention indicating the end of learning period. Significantly less surgical trauma has been observed along with development of surgery. CONCLUSION: Improved results are achieved by reduced dissection of adhesions, the use of mechanical suture for intestinal anastomosis and increased number of anastomoses made in intracorporeal fashion.