Rethinking routine technical choices in minor surgery: a retrospective cohort study of implantable venous port...

This study aimed to evaluate whether two commonly overlooked technical choices, preoperative skin marking and electrocautery use, independently affect procedural success and long-term outcomes, using implantable venous port catheter placement as a model procedure within minor surgery.

This retrospective single-center study analyzed 1,122 consecutive port catheter placements, used as a model minor surgical procedure, performed by a single surgeon between June 2022 and September 2025. Preoperative skin marking and electrocautery use were recorded as primary technical variables. The primary outcome was port catheter revision requiring surgical intervention. Learning curve effects were assessed using cumulative sum (CUSUM) analysis. Multivariable logistic regression and Kaplan-Meier analyses were performed to identify independent predictors.

Omission of preoperative skin marking was the sole independent predictor of procedural failure in port catheter placement, increasing failure risk 6.07-fold (odds ratio [OR], 6.07; 95% confidence interval [CI], 2.63-14.01; P < 0.001). Port catheter revision occurred in 4.2% of patients. Electrocautery use was a strong independent predictor of revision (OR, 8.89; 95% CI, 1.77-44.70; P = 0.008) and was associated with significantly lower revision-free survival (hazard ratio, 3.52; P = 0.002). CUSUM analysis demonstrated that the reduction in port catheter revisions after electrocautery discontinuation occurred independently of the overall learning curve.

Preoperative skin marking improves procedural accuracy, while avoidance of electrocautery markedly reduces revision risk, independent of surgical experience, highlighting the critical impact of routine technical decisions in port catheter placement as a model of minor surgical procedures.