Department of Urology, "S.Pio da Pietrelcina" Hospital, Via San Camillo de Lellis,1, 66054, Vasto, CH, Italy.
Urology Department, Urological Research Institute, IRCCS Ospedale San Raffaele, Ville Turro Division, Milan, Italy.
Urolithiasis. 2017 Aug;45(4):387-392. doi: 10.1007/s00240-016-0919-0. Epub 2016 Sep 16.
The aim of this study is to evaluate if surgical experience could influence the outcomes of retrograde intrarenal surgery (RIRS) in terms of stone clearance and complication rate. Patients from five institutions were included in this study. Patients were divided into two groups. Group 1: patients treated by three surgeons in the early phase of learning curve (surgical experience <100 procedures); Group 2: cases operated by two surgeons with great endourological experience (>400 procedures). Patients and stone characteristics, outcome and complications were analyzed. Multivariable regression model was used. Differences between groups were estimated using propensity scores to adjust for the bias inherent to the different characteristics. 381 RIRS were analyzed (Group 1: 150 RIRS; Group 2: 231 RIRS). Clinical data and stone parameters were comparable. The SFR was 70 % in Group 1 and 77.9 % in Group 2 (p = 0.082). Operative time was significantly shorter in the Group 2 (76.3 vs. 53.1 min, p = 0.001). The overall complication rate was significantly lower in Group 2 (20.7 vs. 8.7, p = 0.001). At unadjusted analysis, a non-significant difference was found between centers on SFR (OR 1.51 95 % CI 0.95-2.41). Conversely, a significant difference was found on overall complications (OR 0.36 95 %CI 0.20-0.67) with lower overall complication in Group 2. This study shows that surgeon experience influences the outcomes of RIRS mainly in terms of safety. Further studies will be needed to assess the exact number of procedures necessary to obtain a plateau in the rate of complications and success.
本研究旨在评估手术经验是否会影响经皮肾镜碎石术（RIRS）的结石清除率和并发症发生率。本研究纳入了来自五家机构的患者。患者被分为两组。第 1 组：由三位处于学习曲线早期的外科医生（手术经验<100 例）治疗的患者；第 2 组：由两位具有丰富内镜经验（>400 例）的外科医生治疗的病例。分析了患者和结石特征、结果和并发症。使用多变量回归模型。使用倾向评分来估计组间差异，以调整不同特征所固有的偏差。共分析了 381 例 RIRS（第 1 组：150 例 RIRS；第 2 组：231 例 RIRS）。临床数据和结石参数具有可比性。第 1 组的 SFR 为 70%，第 2 组为 77.9%（p=0.082）。第 2 组的手术时间明显更短（76.3 分钟 vs. 53.1 分钟，p=0.001）。第 2 组的总体并发症发生率明显较低（20.7% vs. 8.7%，p=0.001）。未调整分析时，各中心的 SFR 无显著差异（OR 1.51，95%CI 0.95-2.41）。相反，总体并发症存在显著差异（OR 0.36，95%CI 0.20-0.67），第 2 组的总体并发症较低。本研究表明，外科医生经验主要在安全性方面影响 RIRS 的结果。需要进一步研究来评估获得并发症和成功率稳定所需的确切手术次数。
