Mastering Ultrasound-Guided Percutaneous Central Venous Port Placement in Pediatric Surgery: Navigating the Learning Curve

Ultrasound-guided percutaneous central venous port (CVP) placement offers a minimally invasive approach for pediatric patients, but like many surgical techniques, it has its own set of challenges and potential complications, both in the short and long term. For beginner pediatric surgeons, the learning curve is particularly significant, influencing factors such as operative time and the rate of complications.

A recent study examined the learning curve, progress, outcomes, and complications associated with ultrasound-guided percutaneous CVP placement in children performed by a single beginner pediatric surgeon. The study's findings revealed two distinct stages in the learning curve: the initial 15 cases (Stage 1) and the subsequent cases (Stage 2). A clear correlation emerged between the number of cases performed and operative time, with significantly longer times observed during the first stage. Although surgical complications were more frequent in the early phase (26.7%), the difference in complication rates between the two stages was not statistically significant. Notably, a change in the surgeon's position—from the patient's right side to the head—led to a significant reduction in operative time, underscoring the impact of operator positioning on surgical outcomes.

This study highlights that ultrasound-guided percutaneous CVP placement is a safe and effective procedure. It allows a beginner pediatric surgeon to surmount the learning curve after just 15 cases and has a relatively low complication rate compared to other pediatric surgeries. Moreover, the study emphasizes the importance of proper operator positioning in achieving optimal surgical outcomes. 

Source: Jeon HJ, Ihn K, Ho IG. Learning curve of ultrasound-guided percutaneous central venous port placement in children. BMC Pediatr. 2024;24:507.