Clinical Original Article
Suprapubic-assisted laparoendoscopic single-site nephrectomy: analysis of learning curve in one center
Hui Xu, Guoxi Zhang, Xiaofeng Zou, Yuanhu Yuan, Rihai Xiao, Gengqing Wu, Xiaoning Wang, Yijun Xue, Dazhi Long, Yuting Wu, Folin Liu, Jun Yang, Yunfeng Liao, tianpeng Xie
Published 2016-08-15
Cite as Chin J Urol, 2016, 37(8): 572-577. DOI: 10.3760/cma.j.issn.1000-6702.2016.08.003
Abstract
ObjectiveTo evaluate the learning curve of Suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) nephrectomy in our center.
MethodsFrom April 2013 to April 2016, 60 patients underwent SA-LESS nephrectomy performed by two associate chief physicians (group B and C, 30 patients in both groups). There were 25 males and 5 females with mean age (48.4±9.4)years in group B, and 23 males and 7 females with mean age (52.6±12.0)years in group C. Operative time, estimated blood loss, converting to conventional laparoscopy or open surgery, intra and postoperative complications in both groups were recorded , The data from both group B and C were compared with those of group A [Standard group with 30 patients who underwent SA-LESS nephrectomy performed by a skillful chief physician, 26 males and 4 females with mean age (50.8±12.3)years]. All the patients in the three groups were diagnosed with upper urinary tract calculus or ureteral stricture with severe ipsilateral hydronephrosis (no-function kidney) and a normal contralateral kidney. The sum of the Cumulative Summation(CUSUM)was also cumulated. Individual learning curve and total learning curve were established.
ResultAll the 30 procedures in group A were successfully completed with an average operative time [(123.3±28.4)min(85~175 min)] and an average estimated blood loss[(121.7±43.1)ml(65~280 ml)]. There were 28 procedures successfully finished in group B and 29 in group C, respectively. The average operative time was [(141.7±49.4)min(90~260 min)] and the average estimated blood loss was [(165.2±81.9)ml(70~450 ml)] in group B, and the average operative time was [(133.1±33.7)min(90~235 min)]and the average estimated blood loss was [(140.0±72.3)ml(75~500 ml)] in group C. There was 1 case converted to conventional laparoscopy and 1 case converted to open surgery in group B with 4 (13.3%) complications (Satava Ⅰ 2 cases, Satava Ⅱ 1 case, Clavien-Dindo Ⅰ 1 case) in all. There was 1 case converted to conventional laparoscopy in group C with 4 (13.3%) complications (Satava Ⅰ 1 case, Satava Ⅱ 2 cases, Clavien-Dindo Ⅱ 1 case) in all. Statistical analysis showed that the number corresponding to the slope changed into negative was 15 and 11 for group B and C, respectively, and 13 was confirmed in the total learning curve.
ConclusionsSA-LESS nephrectomy could be feasible and safe for an experienced laparoscopic surgeon, who may master it after he finished 13 cases of SA-LESS nephrectomy.
Key words:
Laparoendoscopic single-site surgery; Nephrectomy; Learning curve; Cumulative summation
Contributor Information
Hui Xu
Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, 341000, China
Guoxi Zhang
Xiaofeng Zou
Yuanhu Yuan
Rihai Xiao
Gengqing Wu
Xiaoning Wang
Yijun Xue
Dazhi Long
Yuting Wu
Folin Liu
Jun Yang
Yunfeng Liao
tianpeng Xie