Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea.
J Endourol. 2009 Dec;23(12):1965-9. doi: 10.1089/end.2008.0636.
We evaluated the number of cases necessary to develop competence for performing laparoscopic radical nephrectomy (LRN) by chronologically analyzing the results of 150 cases.
150 patients were included in this study, each of whom had had pure transperitoneal LRNs between March 2003 and February 2008 performed by three surgeons who were all novices in laparoscopic surgery. Each surgeon performed 50 LRNs. These were divided into 10 groups chronologically, with five cases in each group (individual-group). Subsequently, we combined the data of the three surgeons, with 15 cases assigned to each group (combined-group). We identified the groups that demonstrated a statistically significant difference in operative time, compared with the most recent group. Based on this finding, we divided the cases into two groups: The novice group and the competent group. The complication rate, transfusion rate, and estimated blood loss were then compared between the two groups.
The total average operative time was 187.6 +/- 46.56 minutes; from group 4 onward, there was no significant decrease in the operative time. Therefore, groups 1 to 3 were defined as the novice groups, and groups 4 to 10 as the competent groups. Incidence of intraoperative complications was six (13.3%) in the novice group and nine (8.6%) in the competent group. There were 14 cases with postoperative complications--4 (8.9%) in the novice group and 10 (9.5%) in the competent group. There were significant differences in the estimated blood loss and transfusion rate between the novice and competent groups (236.4 +/- 41.85 mL vs 191.5 +/- 21.9 mL, 17.8% vs 4.8%, respectively).
Our results suggest that 15 cases are needed for a novice surgeon to achieve competence in LRN. Surgical outcomes and morbidity can be improved once this learning curve has been overcome.
通过对 150 例病例的结果进行时间顺序分析，评估腹腔镜根治性肾切除术（LRN）的胜任能力所需的病例数。
本研究纳入了 150 例患者，每位患者均由 3 位腹腔镜手术新手外科医生行纯经腹腔 LRN，手术时间均在 2003 年 3 月至 2008 年 2 月之间。每位外科医生进行了 50 例 LRN。这些病例按时间顺序分为 10 组，每组 5 例（个体组）。随后，我们将 3 位外科医生的数据合并，每组 15 例（联合组）。我们确定了与最近一组相比手术时间存在统计学差异的组。基于这一发现，我们将病例分为两组：新手组和胜任组。然后比较两组之间的并发症发生率、输血率和估计出血量。
总平均手术时间为 187.6 +/- 46.56 分钟；从第 4 组开始，手术时间没有明显下降。因此，第 1 至 3 组定义为新手组，第 4 至 10 组定义为胜任组。新手组术中并发症发生率为 6 例（13.3%），胜任组为 9 例（8.6%）。术后并发症 14 例，新手组 4 例（8.9%），胜任组 10 例（9.5%）。新手组和胜任组之间估计出血量和输血率有显著差异（236.4 +/- 41.85 毫升比 191.5 +/- 21.9 毫升，17.8%比 4.8%）。
我们的结果表明，新手外科医生需要 15 例病例才能胜任 LRN。一旦克服了学习曲线，手术结果和发病率就可以得到改善。
