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Article: The learning curve of computer-assisted free flap jaw reconstruction surgery using 3D-printed patient-specific plates: a cumulative sum analysis
Title | The learning curve of computer-assisted free flap jaw reconstruction surgery using 3D-printed patient-specific plates: a cumulative sum analysis |
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Authors | |
Keywords | Computer-assisted jaw reconstruction Virtual surgical planning Patient-specific surgical plate Three-dimensional printing technology Learning curve Cumulative sum analysis |
Issue Date | 2021 |
Publisher | Frontiers Research Foundation. The Journal's web site is located at http://www.frontiersin.org/oncology |
Citation | Frontiers in Oncology, 2021, v. 11, article no. 737769 How to Cite? |
Abstract | Background: Computer-assisted jaw reconstruction (CAJR) has benefits in reducing operation time and improving reconstruction accuracy, compared to conventional freehand jaw reconstruction. However, no information is available regarding learning curves in CAJR with the use of 3D-printed patient-specific surgical plates (PSSP). The purpose of this study was to assess surgical outcomes and learning curve for the first 58 consecutive CAJR using 3D-printed PSSP performed by a single surgical team in a single institution.
Methods: In a prospective study, consecutive patients who underwent free flap CAJR using 3D-printed PSSP were included. The determination of proficiency, based on the cumulative sum of surgical success (no major adjustment of 3D-printed PSSP, flap survival) passing the acceptable boundary line of cumulative sum analysis, was the primary outcome. To find out any potential factors influencing the learning curve, baseline characteristics of patients were compared before and after proficiency achievement. Secondary outcomes included inflexion points of the total operation time, blood loss, length of hospital stay, and bone graft deviation, measured by the cumulative sum analysis.
Results: From December 2016 to November 2020, 58 consecutive cases underwent surgery performed by a single surgical team. The overall surgical success rate was 94.8% (55/58). A three-stage learning curve of primary outcome was observed. The proficiency was achieved after 23 cases. The proportions of advanced tumor staging and concomitant surgery after obtaining proficiency were significantly higher than those before achieving proficiency (p = 0.046 and p < 0.001, respectively). Mean values of operation time, intraoperative blood loss, length of hospital stay, and bone graft deviation were 532.5 ± 119.2 min, 1,006.8 ± 547.2 ml, 16.1 ± 6.3 days, and 0.9 ± 1.2 mm, respectively. Two trends of learning curve were observed in the CUSUM analyses of total operation time, length of hospital stay, and bone graft deviation, in which the first and second inflexion points occurred between 8 and 17 cases and between 43 and 46 cases, respectively.
Conclusion: Our results revealed a three-stage learning curve of CAJR with the use of PSSP, including initial learning, plateau, and overlearning. Based on CUSUM analysis, the surgical proficiency was achieved after 23 cases, and total operation time, length of hospital stay, and bone graft deviation stabilized after 8–17 cases. |
Persistent Identifier | http://hdl.handle.net/10722/302448 |
ISSN | 2023 Impact Factor: 3.5 2023 SCImago Journal Rankings: 1.066 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Zhu, W | - |
dc.contributor.author | Choi, WS | - |
dc.contributor.author | Wong, MCM | - |
dc.contributor.author | Pu, JJ | - |
dc.contributor.author | Yang, W | - |
dc.contributor.author | Su, Y | - |
dc.date.accessioned | 2021-09-06T03:32:26Z | - |
dc.date.available | 2021-09-06T03:32:26Z | - |
dc.date.issued | 2021 | - |
dc.identifier.citation | Frontiers in Oncology, 2021, v. 11, article no. 737769 | - |
dc.identifier.issn | 2234-943X | - |
dc.identifier.uri | http://hdl.handle.net/10722/302448 | - |
dc.description.abstract | Background: Computer-assisted jaw reconstruction (CAJR) has benefits in reducing operation time and improving reconstruction accuracy, compared to conventional freehand jaw reconstruction. However, no information is available regarding learning curves in CAJR with the use of 3D-printed patient-specific surgical plates (PSSP). The purpose of this study was to assess surgical outcomes and learning curve for the first 58 consecutive CAJR using 3D-printed PSSP performed by a single surgical team in a single institution. Methods: In a prospective study, consecutive patients who underwent free flap CAJR using 3D-printed PSSP were included. The determination of proficiency, based on the cumulative sum of surgical success (no major adjustment of 3D-printed PSSP, flap survival) passing the acceptable boundary line of cumulative sum analysis, was the primary outcome. To find out any potential factors influencing the learning curve, baseline characteristics of patients were compared before and after proficiency achievement. Secondary outcomes included inflexion points of the total operation time, blood loss, length of hospital stay, and bone graft deviation, measured by the cumulative sum analysis. Results: From December 2016 to November 2020, 58 consecutive cases underwent surgery performed by a single surgical team. The overall surgical success rate was 94.8% (55/58). A three-stage learning curve of primary outcome was observed. The proficiency was achieved after 23 cases. The proportions of advanced tumor staging and concomitant surgery after obtaining proficiency were significantly higher than those before achieving proficiency (p = 0.046 and p < 0.001, respectively). Mean values of operation time, intraoperative blood loss, length of hospital stay, and bone graft deviation were 532.5 ± 119.2 min, 1,006.8 ± 547.2 ml, 16.1 ± 6.3 days, and 0.9 ± 1.2 mm, respectively. Two trends of learning curve were observed in the CUSUM analyses of total operation time, length of hospital stay, and bone graft deviation, in which the first and second inflexion points occurred between 8 and 17 cases and between 43 and 46 cases, respectively. Conclusion: Our results revealed a three-stage learning curve of CAJR with the use of PSSP, including initial learning, plateau, and overlearning. Based on CUSUM analysis, the surgical proficiency was achieved after 23 cases, and total operation time, length of hospital stay, and bone graft deviation stabilized after 8–17 cases. | - |
dc.language | eng | - |
dc.publisher | Frontiers Research Foundation. The Journal's web site is located at http://www.frontiersin.org/oncology | - |
dc.relation.ispartof | Frontiers in Oncology | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | Computer-assisted jaw reconstruction | - |
dc.subject | Virtual surgical planning | - |
dc.subject | Patient-specific surgical plate | - |
dc.subject | Three-dimensional printing technology | - |
dc.subject | Learning curve | - |
dc.subject | Cumulative sum analysis | - |
dc.title | The learning curve of computer-assisted free flap jaw reconstruction surgery using 3D-printed patient-specific plates: a cumulative sum analysis | - |
dc.type | Article | - |
dc.identifier.email | Choi, WS: drwchoi@hku.hk | - |
dc.identifier.email | Wong, MCM: mcmwong@hku.hk | - |
dc.identifier.email | Yang, W: teddyrun@hku.hk | - |
dc.identifier.email | Su, Y: richsu@hku.hk | - |
dc.identifier.authority | Choi, WS=rp01521 | - |
dc.identifier.authority | Wong, MCM=rp00024 | - |
dc.identifier.authority | Yang, W=rp02768 | - |
dc.identifier.authority | Su, Y=rp01916 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.3389/fonc.2021.737769 | - |
dc.identifier.pmid | 34604076 | - |
dc.identifier.pmcid | PMC8481918 | - |
dc.identifier.scopus | eid_2-s2.0-85116273841 | - |
dc.identifier.hkuros | 324835 | - |
dc.identifier.volume | 11 | - |
dc.identifier.spage | article no. 737769 | - |
dc.identifier.epage | article no. 737769 | - |
dc.identifier.isi | WOS:000702084900001 | - |
dc.publisher.place | Switzerland | - |