Park Jee Soo, Ahn Hyun Kyu, Na Joonchae, Lee Hyung Ho, Yoon Young Eun, Yoon Min Gee, Han Woong Kyu
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Urology, National Health Insurance Service Ilsan Hospital.
Medicine (Baltimore). 2019 Apr;98(17):e15367. doi: 10.1097/MD.0000000000015367.
Video-assisted mini-laparotomy surgery (VAMS), a hybrid of open and laparoscopic surgical techniques, is an important surgical approach in the field of partial nephrectomy. The learning curve for VAMS partial nephrectomy has not been studied to date; we therefore, evaluated this learning curve.We prospectively evaluated 20 consecutive patients who underwent VAMS partial nephrectomy performed by a single surgeon (YEY) between March 2015 and December 2016. The learning curve was evaluated using the cumulative sum method. The measure of surgical performance was composed of 3 parameters (total operation time [Op time], warm ischemic time [WIT], and estimated blood loss [EBL]).Among the 20 patients who underwent VAMS partial nephrectomy, the mean age was 54.6 years. The mean Op time and WIT were 172.5 and 28.8 minutes, respectively. The learning curve for the Op time, WIT, and EBL consisted of 3 unique phases: phase 1 (the first 7 cases), phase 2 (the next 5 to 7 cases), and phase 3 (all subsequent cases). Phase 1 represents the initial learning curve, and the phase 2 plateau represents the period of expert competency. Phase 3 represents when one is competent in VAMS partial nephrectomy.The learning curve for VAMS partial nephrectomy is relatively short and after a learning curve of approximately 7 cases, the surgeon became familiar with VAMS partial nephrectomy; after 12 to 14 cases, the surgeon became competent in this procedure.
视频辅助小切口腹腔镜手术（VAMS）是一种开放手术与腹腔镜手术技术相结合的手术方式，是部分肾切除术领域的一种重要手术方法。迄今为止，尚未对VAMS部分肾切除术的学习曲线进行研究；因此，我们对该学习曲线进行了评估。
我们前瞻性地评估了2015年3月至2016年12月期间由单一外科医生（YEY）实施VAMS部分肾切除术的20例连续患者。使用累积和法评估学习曲线。手术表现的衡量指标由3个参数组成（总手术时间[Op时间]、热缺血时间[WIT]和估计失血量[EBL]）。
在接受VAMS部分肾切除术的20例患者中，平均年龄为54.6岁。平均Op时间和WIT分别为172.5分钟和28.8分钟。Op时间、WIT和EBL的学习曲线包括3个独特阶段：第1阶段（前7例）、第2阶段（接下来的5至7例）和第3阶段（所有后续病例）。第1阶段代表初始学习曲线，第2阶段平台期代表专家胜任期。第3阶段代表外科医生能够熟练进行VAMS部分肾切除术。
VAMS部分肾切除术的学习曲线相对较短，在大约7例的学习曲线后，外科医生熟悉了VAMS部分肾切除术；在12至14例后，外科医生能够熟练进行该手术。
