Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey.
Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey.
Urology. 2020 Jun;140:22-26. doi: 10.1016/j.urology.2020.03.022. Epub 2020 Apr 5.
To evaluate the effect of learning curve on supine mini-percutaneous nephrolithotomy (PNL) outcomes.
The aim of the study was to include a total of 75 patients. All of the patients were operated on by the same team, which had experience of at least 100 prone mini-PNL cases. The team was led by a surgeon who had observed 40 supine conventional PNL procedures (sheath size 24 Fr) over a period of 3 months at an endourology center with experience in supine PNL and surgeries were performed by the same primary surgeon. Patients were divided equally into 5 groups, as first 15 cases in Group 1, and final 15 in Group 5. Groups were compared according to preoperative characteristic, intraoperative result, complication rate, and success rate.
The mean access time was 14 minutes in group 1. It decreased to mean of 10.3 minutes for cases 31 through 45, and afterward significant decrease occurred up to a mean of 6.5 minutes for cases 61 through 75 (P ≤.001). According to the Clavien-Dindo classification system, complications were assessed, and a decrease was observed from group 1 to group 5 (40%, 20%, 26.6%, 6.7%, and 13.3%, respectively). The stone free rate increased from the mean of 66.7% for the first two groups to 80% for group 3 and increase up to the 93.3% for group 4 and 5 (P = .128).
The present study showed that considering the decrease in access time and operation time 60 patients could be enough for surgical competency as well as the complications and stone-free rates reached satisfactory levels after 45 patients.
评估学习曲线对仰卧位微创经皮肾镜取石术（PNL）结果的影响。
本研究的目的是纳入共 75 例患者。所有患者均由同一团队进行手术，该团队至少有 100 例俯卧位微创经皮肾镜取石术（PNL）经验。该团队由一名外科医生领导，该外科医生在一家具有仰卧位 PNL 经验的内镜中心观察了 40 例仰卧位传统 PNL 手术（鞘大小 24Fr），历时 3 个月，手术由同一名初级外科医生进行。患者平均分为 5 组，第 1 组前 15 例，第 5 组最后 15 例。根据术前特征、术中结果、并发症发生率和成功率对组进行比较。
第 1 组的平均进入时间为 14 分钟。对于第 31 至 45 例，它减少到平均 10.3 分钟，之后对于第 61 至 75 例，显著减少到平均 6.5 分钟（P≤.001）。根据 Clavien-Dindo 分类系统评估并发症，从第 1 组到第 5 组观察到减少（分别为 40%、20%、26.6%、6.7%和 13.3%）。结石清除率从前两组的平均 66.7%增加到第 3 组的 80%，并增加到第 4 组和第 5 组的 93.3%（P=.128）。
本研究表明，考虑到进入时间和手术时间的减少，60 例患者足以达到手术能力，并且在 45 例患者后并发症和结石清除率达到了令人满意的水平。
