PURPOSE: With the global epidemic of obesity, the importance of metabolic and bariatric surgery (MBS) is greater than ever before. Performing these surgeries requires academic training and the completion of a dedicated fellowship training program. This study aimed to develop guidelines based on expert consensus using a modified Delphi method to create the criteria for metabolic and bariatric surgeons that must be mastered before obtaining privileges to perform MBS. METHODS: Eighty-nine recognized MBS surgeons from 42 countries participated in the Modified Delphi consensus to vote on 30 statements in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was regarded to indicate a consensus. RESULTS: Consensus was reached on 29 out of 30 statements. Most experts agreed that before getting privileges to perform MBS, surgeons must hold a general surgery degree and complete or have completed a dedicated fellowship training program. The experts agreed that the learning curves for the various operative procedures are approximately 25-50 operations for the LSG, 50-75 for the OAGB, and 75-100 for the RYGB. 93.1% of experts agreed that MBS surgeons should diligently record patients' data in their National or Global database. CONCLUSION: MBS surgeons should have a degree in general surgery and have been enrolled in a dedicated fellowship training program with a structured curriculum. The learning curve of MBS procedures is procedure dependent. MBS surgeons must demonstrate proficiency in managing postoperative complications, collaborate within a multidisciplinary team, commit to a minimum 2-year patient follow-up, and actively engage in national and international MBS societies.

• MeSH
• bariatrická chirurgie * normy   výchova   MeSH
• chirurgové normy   výchova   MeSH
• delfská metoda * MeSH
• klinické kompetence normy   MeSH
• konsensus * MeSH
• křivka učení MeSH
• lidé MeSH
• morbidní obezita chirurgie   MeSH
• stipendia normy   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY: The annual number of spinal fusion procedures has been increasing and is well documented worldwide. The O-arm is slowly becoming the standard for transpedicular screw insertion. The accuracy and safety of this method have been confirmed by many studies. Therefore, the learning curve of this method and its use by younger surgeons is the focus of our investigation. Longer operative time and radiation exposure to the patient are its only disadvantages. Our aim was to evaluate the learning curve of neurosurgical residents receiving specialist training and to demonstrate the safety and accuracy compared to the conventional C-arm-guided screw insertion used in the surgical management of spondylolisthesis. MATERIAL AND METHODS: Two groups of patients were evaluated - a retrospective cohort composed of patients with degenerative lumbar spinal instability indicated for C-arm-guided posterior transpedicular screw fixation and a prospective group of patients with the same diagnosis and surgical indication for O-arm-navigated screw insertion. In the retrospective group, the surgeons were largely experienced certified spine surgeons and neurosurgeons, whereas in the prospective group there were mainly neurosurgical residents receiving specialist training under the supervision of a certified physician. Both groups underwent a postoperative CT scan to evaluate the pedicle screw malposition using the Grade system and the anatomical plane of malposition. The operative times for both groups were recorded and for the O-arm navigated group a learning curve from the introduction of the method was generated. The values obtained were statistically analysed. RESULTS: A relatively favourable learning curve of the O-arm-navigation was obtained, with operative times approximating the Carm-guided group at two years after the introduction of the method. Safety of the O-arm navigation applied by less experienced surgeons was confirmed through statistically significantly higher accuracy achieved in the O-arm group at the expense of longer operative times. Also, a significantly lower number of significant Grade 2 and 3 malposition was reported in the O-arm group. DISCUSSION: The higher accuracy of transpedicular screw insertion in the navigation method has been confirmed multiple times. In our study, even in the group of less experienced surgeons. The favourable learning curve of neurological residents receiving specialist training is less documented. Time efficiency of the method and its safety when applied by younger surgeons could help make O-arm navigation the new gold standard in spine surgery. The longer operative time, the purchase price of the device, and a relatively higher radiation exposure to the patient continue to be its disadvantages. CONCLUSIONS: Based on the data obtained, a conclusion can be drawn that the O-arm navigation in spine surgery represents a safer and more accurate method for transpedicular fixation compared to the conventional C-arm technique, even when used by less experienced surgeons. In future, we should focus on increasing its time-efficiency. We are convinced that the navigationassisted spinal instrumentation will soon become a necessity for spine surgery centres. KEY WORDS: O-arm, transpedicular fixation, spondylolisthesis, fusion, navigation, learning curve.

• MeSH
• bederní obratle * chirurgie   MeSH
• chirurgie s pomocí počítače metody   přístrojové vybavení   MeSH
• délka operace MeSH
• fúze páteře přístrojové vybavení   metody   výchova   MeSH
• kostní šrouby MeSH
• křivka učení * MeSH
• kurzy a stáže v nemocnici MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• retrospektivní studie MeSH
• spondylolistéza * chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND: Perforator mapping using diagnostic methods facilitates deep inferior epigastric perforator (DIEP) flap planning. Computed tomographic angiography (CTA) is a well-proven tool for perforator mapping. However, the benefits of color Doppler ultrasonography (CDU) are as follows: 1) CDU involves dynamic real-time examination and 2) does not use radiation. Comparing the accuracies of both methods in a cohort of patients, this study aimed to evaluate the learning curve of surgeon-conducted CDU perforator mapping. METHODS: Twenty patients undergoing DIEP flap breast reconstruction were enrolled in a cohort study. All patients underwent CTA perforator mapping preoperatively. XY coordinates of significant perforators were subtracted by a radiologist. A single surgeon (sonographer) with minimal experience with CDU performed CDU perforator mapping, including XY coordinates subtraction. The sonographer was blinded to the CTA data. The reference coordinates of dissected perforators were measured during surgery. Deviations from reference coordinates for both methods were compared, and CDU mapping learning curve was assessed using Joinpoint Regression. RESULTS: We included 20 women (32 DIEP flaps and 59 dissected perforators). The mean deviation between mapped and reference coordinates was 1.00 (0.50-1.12) cm for CDU and 0.71 (0.50-1.12) cm for CTA. The learning curve of CDU mapping showed the breaking point after the seventh patient (≈ 21 localized perforators). After the breaking point, no significant differences between the deviations of both methods were found (p = 0.980). CONCLUSION: A limited number of examinations were needed for the surgeon to learn CDU DIEA perforator mapping with accuracy similar to that of CTA mapping.

• MeSH
• arteriae epigastricae diagnostické zobrazování   chirurgie   MeSH
• chirurgové * MeSH
• kohortové studie MeSH
• křivka učení MeSH
• lidé MeSH
• mamoplastika * metody   MeSH
• perforátorový lalok * krevní zásobení   MeSH
• ultrasonografie dopplerovská barevná metody   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Purpose: We aimed to compare the learning curves of an ultrasound trainee (obstetrics and gynecology resident) and a radiology trainee when assessing pelvic endometriosis. Methods: Consecutive patients with suspected endometriosis were prospectively enrolled in a tertiary center. They underwent an ultrasound and magnetic resonance imaging preoperatively, which was reported according to the International Deep Endometriosis Analysis (IDEA) group consensus. Trainees reported on deep endometriosis (DE), endometriomas, frozen pelvis, and adenomyosis. Using the Kappa agreement, their findings were compared against laparoscopy/histology and expert findings. The learning curve was considered positive when performance improved over time and indeterminate in all other cases. Results: Reports from thirty-five women were divided chronologically into 3 equal blocks to assess the learning curve. For ultrasound, trainee versus expert showed a positive learning curve in overall pelvic DE assessment. There was an excellent agreement for adenomyosis (Kappa = 1.00, p = 0.09), frozen pelvis (Kappa = 0.90, p = 0.01), bowel (Kappa = 1.00, p = 0.01), and bladder DE assessment (Kappa = 1.00, p = 0.01). Endometrioma and uterosacral ligament assessment showed an indeterminate curve. For radiology, trainee versus expert showed a positive curve when detecting adenomyosis (Kappa = 0.42, p = 0.09) and bladder DE (Kappa = 1.00, p = 0.01). The assessment of endometriomas, frozen pelvis, overall pelvic DE, bowel, and uterosacral ligament DE showed indeterminate curve. Agreement between trainees and laparoscopy/histology showed a positive curve for bladder (both) and frozen pelvis (ultrasound only). Conclusion: A positive learning curve can be seen in some areas of pelvic endometriosis mapping after as little as 35 cases, but a bigger caseload is required to demonstrate the curve in full. The ultrasound trainee had positive learning curves in more anatomical locations (bladder, adenomyosis, overall bowel DE, frozen pelvis) than the radiology trainee (bladder, adenomyosis), which could be down to individual factors, differences in training, or the imaging method itself.

• MeSH
• dospělí MeSH
• endometrióza diagnostické zobrazování   MeSH
• křivka učení * MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie * MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pánev diagnostické zobrazování   MeSH
• ultrasonografie * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: Arthroscopy of the hip joint is considered a demanding procedure with long learning curve. There are only a few studies that concentrate on this topic. This prospective clinical study evaluates the learning curve of the hip arthroscopy based on clinical outcomes, surgical time, and complication rate. MATERIALS: In this study, we first evaluated 150 hip arthroscopy procedures performed by a single surgeon. The patient group consisted of 86 females and 64 males with mean age 37 years (range 16-69). Study cohorts were divided into groups of 50 patients. Surgical time, complication rate and clinical results based on NAHS score were recorded for each group. Statistical analysis of differences between groups was performed using the ANOVA method and paired t-test. RESULTS: We found a statistically significant decrease of complication rate with more procedures performed. There were significantly better clinical outcomes after at least 100 procedures. No difference in surgical time was found, but towards the end of the learning curve, more complex procedures were performed. The only statistical difference was the portal setup time. The learning curves were constructed based on these results. CONCLUSIONS: Hip arthroscopy provides very good clinical outcomes if precisely indicated and performed. It is, however, a demanding procedure with many possible pitfalls and complications. According to our study, at least 100 procedures are needed to gain basic technical and indication skills. The presence of a more skilled surgeon in the beginning of the learning curve is advised to reduce the complication rate.

• MeSH
• artroskopie škodlivé účinky   výchova   metody   MeSH
• chirurgové výchova   MeSH
• délka operace MeSH
• dospělí MeSH
• femoroacetabulární impingement chirurgie   MeSH
• klinické kompetence statistika a číselné údaje   MeSH
• křivka učení MeSH
• kyčelní kloub chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinická studie MeSH
• práce podpořená grantem MeSH

AIM: Advances in neuroradiological planning techniques in deep brain stimulation have put the need for intraoperative electrophysiological monitoring into doubt. Moreover intraoperative monitoring prolongs surgical time and there is potential association between the use of microelectrodes and increased incidence of hemorrhagic complications. The aim of this study was to analyze the correlation between the anatomically planned trajectory and the final subthalamic electrode placement after electrophysiological monitoring in patients with Parkinson"s disease and its change with the increasing experience of the surgical team. MATERIAL AND METHODS: The trajectories of right (first implanted) and left electrodes were compared in the first 50 patients operated on (Group 1) and the next 50 patients (Group 2). RESULTS: In Group 1, 52% of central trajectories were on the right and 38% on the left; in Group 2, the percentage of central trajectories was 76% on the right and 78% on the left; the difference was statistically significant (p=0.021 and 0.001). The difference in the percentage of posterior trajectories reflecting brain shift between the right and left sides was statistically insignificant in Groups 1 (26% and 28%, p=0.999) and 2 (18% and 12%, p=0.549). The percentage of bilateral central electrodes was 14% and 62% in Groups 1 and 2, respectively. CONCLUSION: The correlation between anatomically planned trajectory and final electrode placement markedly improves with the number of patients. However the significant percentage of patients with final electrode trajectory differing from anatomically planned target supports the use of intraoperative monitoring.

• MeSH
• hluboká mozková stimulace metody   MeSH
• implantované elektrody MeSH
• intraoperační neurofyziologická monitorace * MeSH
• klinické kompetence MeSH
• křivka učení * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikroelektrody MeSH
• nucleus subthalamicus fyziologie   MeSH
• Parkinsonova nemoc chirurgie   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: Use of novel medical technologies, such as leadless pacemaker (LP) therapy, may be subjected to a learning curve effect. The objective of the current study was to assess the impact of operators' experience on the occurrence of serious adverse device effects (SADE) and procedural efficiency. METHODS: Patients implanted with a Nanostim LP (Abbott, USA) within two prospective studies (i.e., LEADLESS ll IDE and Leadless Observational Study) were assessed. Patients were categorized into quartiles based on operator experience. Learning curve analysis included the comparison of SADE rates at 30 days post-implant per quartile and between patients in quartile 4 (> 10 implants) and patients in quartiles 1 through 3 (1-10 implants). Procedural efficiency was assessed based on procedure duration and repositioning attempts. RESULTS: Nanostim LP implant was performed in 1439 patients by 171 implanters at 60 centers in 10 countries. A total of 91 (6.4%) patients experienced a SADE in the first 30 days. SADE rates dropped from 7.4 to 4.5% (p = 0.038) after more than 10 implants per operator. Total procedure duration decreased from 30.9 ± 19.1 min in quartile 1 to 21.6 ± 13.2 min (p < 0.001) in quartile 4. The need for multiple repositionings during the LP procedure reduced in quartile 4 (14.8%), compared to quartiles 1 (26.8%; p < 0.001), 2 (26.6%; p < 0.001), and 3 (20.4%; p = 0.03). CONCLUSIONS: Learning curves exist for Nanostim LP implantation. Procedure efficiency improved with increased operator experience, according to a decrease in the incidence of SADE, procedure duration, and repositioning attempts.

• MeSH
• časové faktory MeSH
• design vybavení * MeSH
• implantované elektrody MeSH
• internacionalita MeSH
• kardiostimulace umělá škodlivé účinky   metody   MeSH
• kardiostimulátor * MeSH
• křivka učení * MeSH
• lidé MeSH
• logistické modely MeSH
• monitorování fyziologických funkcí metody   MeSH
• multivariační analýza MeSH
• plnění a analýza úkolů MeSH
• prognóza MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční arytmie diagnostické zobrazování   terapie   MeSH
• srdeční elektrofyziologie výchova   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• srovnávací studie MeSH

AIMS: The subcutaneous implantable cardioverter defibrillator (S-ICD) was introduced to overcome complications related to transvenous leads. Adoption of the S-ICD requires implanters to learn a new implantation technique. The aim of this study was to assess the learning curve for S-ICD implanters with respect to implant-related complications, procedure time, and inappropriate shocks (IASs). METHODS AND RESULTS: In a pooled cohort from two clinical S-ICD databases, the IDE Trial and the EFFORTLESS Registry, complications, IASs at 180 days follow-up and implant procedure duration were assessed. Patients were grouped in quartiles based on experience of the implanter and Kaplan-Meier estimates of complication and IAS rates were calculated. A total of 882 patients implanted in 61 centres by 107 implanters with a median of 4 implants (IQR 1,8) were analysed. There were a total of 59 patients with complications and 48 patients with IAS. The complication rate decreased significantly from 9.8% in Quartile 1 (least experience) to 5.4% in Quartile 4 (most experience) (P = 0.02) and non-significantly for IAS from 7.9 to 4.8% (P = 0.10). Multivariable analysis demonstrated a hazard ratio of 0.78 (P = 0.045) for complications and 1.01 (P = 0.958) for IAS. Dual-zone programming increased with experience of the individual implanter (P < 0.001), which reduced IAS significantly in the multivariable model (HR 0.44, P = 0.01). Procedure time decreased from 75 to 65 min (P < 0.001). The complication rate and procedure time stabilized after Quartile 2 (>13 implants). CONCLUSION: There is a short and significant learning curve associated with physicians adopting the S-ICD. Performance stabilizes after 13 implants.

• MeSH
• databáze faktografické MeSH
• defibrilátory implantabilní * MeSH
• dospělí MeSH
• elektrická defibrilace * MeSH
• implantace protézy výchova   MeSH
• Kaplanův-Meierův odhad MeSH
• kardiochirurgické výkony výchova   MeSH
• křivka učení * MeSH
• lidé středního věku MeSH
• lidé MeSH
• multivariační analýza MeSH
• následné studie MeSH
• proporcionální rizikové modely MeSH
• registrace MeSH
• rizikové faktory MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH

Cíl: Karotická angioplastika je preventivní metoda, jejímž účelem je snížit riziko mozkové ischemie způsobené stenózou odstupu vnitřní karotické tepny. K dosažení tohoto účelu je třeba, aby výkon měl nízké riziko komplikací a jeho efekt dlouho přetrvával. Cílem naší práce bylo ověřit bezpečnost karotických angioplastik a jejich dlouhodobý účinek v klinické praxi. Materiál a metodika: Soubor tvoří 450 angioplastik, z nichž 442 bylo s implantací stentu, které jsme provedli od roku 1997 u 414 nemocných. Zaznamenávali jsme komplikace během tří dnů po výkonu (periprocedurální) a v průběhu dlouhodobého UZ a klinického sledování (medián 33 měsíců). Výsledky: Riziko angioplastiky bylo nízké: hospitalizační mortalita = mozkové krvácení 0,5 %, mozková ischemie (minor stroke) 1,0 %, tranzitorní ischemická ataka 2,4 %. Restenózu > 70 % jsme v dalším průběhu zjistili u 3,6 % ze 76 % dlouhodobě sledovaných nemocných, 81 % restenóz bylo asymptomatických. Závěry: Naše výsledky potvrzují, že angioplastika je při správné indikaci a provedení zkušeným operatérem metoda bezpečná a její pozitivní efekt dlouho přetrvává.

Aim: Carotid artery angioplasty is a preventive measure to decrease a risk of cerebral ischemia due to stenosis of the internal carotid artery bifurcation. To achieve this purpose, it is crucial that the procedure has a minimal risk of complications and its effect is long-lasting. The purpose of our study was to verify safety of carotid angioplasty and its long-term effect in clinical practice. Material and method: The study included 450 patients with 442 carotid artery stents and 8 plain carotid angioplasties since 1997. Complications occurring during the first three days after the procedure (periprocedural complications) and during long-term clinical and ultrasonographical follow-up (median 33 months) were recorded. Results: The risk associated with carotid angioplasty was low: in hospital mortality due to intracerebral hemorrhage was 0.5%, minor stroke occurred in 1.0%, transient ischemic attack in 2.4%. > 70% restenosis was found in 3.6% of the 76% of all patients who had long-term follow-up. Asymptomatic restenoses were 81%. Conclusions: Our results confirmed that carotid angioplasty is a safe method with beneficial long-term effect if it is done for appropriate indication and performed by a skilled intervention radiologist.

• Klíčová slova
• karotický stenting, restenóza,
• MeSH
• angioplastika * mortalita   statistika a číselné údaje   škodlivé účinky   MeSH
• endovaskulární výkony MeSH
• hodnocení rizik MeSH
• křivka učení MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenóza arteria carotis * terapie   MeSH
• stenty MeSH
• věkové faktory MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH

Femorální arterie potkana je zcela jistě nejužívanějším modelem pro učení v mikrochirurgii vzhledem možnosti jejího snadného oddělení. Vytvoření několika anastomóz v řadě může vést ke kumulativní technické chybě, která se prokáže negativním testem průchodnosti. Navrhujeme jednoduchou metodu hodnocení operatérovy mikrochirurgické zručnosti během výuky.

The rat's femoral artery is definitely the most frequently used model in microsurgical training for its easy dissection. Our model, consisting in the creation of several anastomoses in a row, helps the novice surgeon to assess his microsurgical level and to improve his capacity. Indeed, this leads to an amplification of the trainee surgeon's mistakes, which add up to each other as the anastomoses are performed. We propose a simple method to evaluate the surgeon microsurgical skills during the training.

• MeSH
• anastomóza chirurgická výchova   MeSH
• arteria femoralis chirurgie   MeSH
• křivka učení MeSH
• krysa rodu rattus MeSH
• lidé MeSH
• mikrochirurgie výchova   MeSH
• modely u zvířat * MeSH
• plastická chirurgie výchova   MeSH
• potkani Wistar MeSH
• průchodnost cév fyziologie   MeSH
• studium lékařství MeSH
• výkony cévní chirurgie * výchova   MeSH
• výuka - hodnocení * statistika a číselné údaje   MeSH
• Check Tag
• krysa rodu rattus MeSH
• lidé MeSH