| Title |
Establishing the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms
|
|---|---|
| Published in |
Surgical Endoscopy, August 2017
|
| DOI | 10.1007/s00464-017-5817-1 |
| Pubmed ID | |
| Authors |
Lawrence Lee, Justin Kelly, George J. Nassif, Deborah Keller, Teresa C. Debeche-Adams, Paul A. Mancuso, John R. Monson, Matthew R. Albert, Sam B. Atallah |
| Abstract |
Transanal minimally invasive surgery (TAMIS) is an endoscopic operating platform for local excision of rectal neoplasms. However, it may be technically demanding, and its learning curve has yet to be adequately defined. The objective of this study was to determine the number of TAMIS procedures for the local excision of rectal neoplasm required to reach proficiency. All TAMIS cases performed from 07/2009 to 12/2016 at a single high-volume tertiary care institution for local excision of benign and malignant rectal neoplasia were identified from a prospective database. A cumulative summation (CUSUM) analysis was performed to determine the number of cases required to reach proficiency. The main proficiency outcome was rate of margin positivity (R1 resection). The acceptable and unacceptable R1 rates were defined as the R1 rate of transanal endoscopic microsurgery (TEM-10%) and traditional transanal excision (TAE-26%), which was obtained from previously published meta-analyses. Comparisons of patient, tumor, and operative characteristics before and after TAMIS proficiency were performed. A total of 254 TAMIS procedures were included in this study. The overall R1 resection rate was 7%. The indication for TAMIS was malignancy in 57%. CUSUM analysis reported that TAMIS reached an acceptable R1 rate between 14 and 24 cases. Moving average plots also showed that the mean operative times stabilized by proficiency gain. The mean lesion size was larger after proficiency gain (3.0 cm (SD 1.5) vs. 2.3 cm (SD 1.3), p = 0.008). All other patient, tumor, and operative characteristics were similar before and after proficiency gain. TAMIS for local excision of rectal neoplasms is a complex procedure that requires a minimum of 14-24 cases to reach an acceptable R1 resection rate and lower operative duration. |
X Demographics
The data shown below were collected from the profiles of 12 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 4 | 33% |
| United Kingdom | 2 | 17% |
| Egypt | 1 | 8% |
| Spain | 1 | 8% |
| Unknown | 4 | 33% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Practitioners (doctors, other healthcare professionals) | 4 | 33% |
| Scientists | 3 | 25% |
| Members of the public | 3 | 25% |
| Science communicators (journalists, bloggers, editors) | 2 | 17% |
Mendeley readers
The data shown below were compiled from readership statistics for 32 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 32 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 6 | 19% |
| Researcher | 5 | 16% |
| Student > Doctoral Student | 3 | 9% |
| Other | 2 | 6% |
| Professor > Associate Professor | 2 | 6% |
| Other | 3 | 9% |
| Unknown | 11 | 34% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 18 | 56% |
| Decision Sciences | 1 | 3% |
| Engineering | 1 | 3% |
| Unknown | 12 | 38% |
Attention Score in Context
This research output has an Altmetric Attention Score of 6. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 20 August 2017.
All research outputs
#6,119,844
of 23,577,761 outputs
Outputs from Surgical Endoscopy
#1,102
of 6,259 outputs
Outputs of similar age
#94,557
of 317,583 outputs
Outputs of similar age from Surgical Endoscopy
#38
of 144 outputs
Altmetric has tracked 23,577,761 research outputs across all sources so far. This one has received more attention than most of these and is in the 73rd percentile.
So far Altmetric has tracked 6,259 research outputs from this source. They receive a mean Attention Score of 4.1. This one has done well, scoring higher than 82% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 317,583 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 69% of its contemporaries.
We're also able to compare this research output to 144 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 73% of its contemporaries.