Takagi Kosei, Kimenai Hendrikus J A N, Terkivatan Turkan, Tran Khe T C, Ijzermans Jan N M, Minnee Robert C
Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Int J Surg. 2021 Feb;86:7-12. doi: 10.1016/j.ijsu.2020.12.011. Epub 2021 Jan 9.
Few studies have investigated the learning curves of minimally invasive donor nephrectomy (MIDN) using the cumulative sum (CUSUM) analysis. In addition, no study has compared the learning curves of the different surgical MIDN techniques in one cohort study using the CUSUM analysis. This study aims to evaluate and compare learning curves for several MIDN using the CUSUM analysis.
A retrospective review of consecutive donors, who underwent MIDN between 1997 and 2019, was conducted. Three laparoscopic-assisted techniques were applied in our institution and included for analysis: laparoscopic (LDN), hand-assisted retroperitoneoscopic (HARP), and robot-assisted laparoscopic (RADN) donor nephrectomy. The outcomes were compared based on surgeon volume to develop learning curves for the operative time per surgeon.
Out of 1895 MIDN, 1365 (72.0%) were LDN, 427 (22.5%) were HARP, and 103 (5.4%) were RADN. The median operative time and median blood loss were 179 (IQR, 139-230) minutes and 100 (IQR, 40-200) mL, respectively. The incidence of major complication was 1.2% with no mortality, and the median hospital stay was three (IQR, 3-4) days. The CUSUM analysis resulted in learning curves, defined by decreased operative time, of 23 cases in LDN, 45 cases in HARP, and 26 cases in RADN.
Our study shows different learning curves in three MIDN techniques with equal post-operative complications. The LDN and RADN learning curves are shorter than that of the hand-assisted donor nephrectomy. Our observations can be helpful for informing the development of teaching requirements for fellows to be trained in MIDN.
很少有研究使用累积和（CUSUM）分析来研究微创供体肾切除术（MIDN）的学习曲线。此外，在一项队列研究中，尚无研究使用CUSUM分析比较不同手术MIDN技术的学习曲线。本研究旨在使用CUSUM分析评估和比较几种MIDN的学习曲线。
对1997年至2019年间接受MIDN的连续供体进行回顾性研究。我们机构应用了三种腹腔镜辅助技术并纳入分析：腹腔镜（LDN）、手辅助后腹腔镜（HARP）和机器人辅助腹腔镜（RADN）供体肾切除术。根据外科医生的手术量比较结果，以绘制每位外科医生手术时间的学习曲线。
在1895例MIDN中，1365例（72.0%）为LDN，427例（22.5%）为HARP，103例（5.4%）为RADN。中位手术时间和中位失血量分别为179（四分位间距，139 - 230）分钟和100（四分位间距，40 - 200）毫升。主要并发症发生率为1.2%，无死亡病例，中位住院时间为3（四分位间距，3 - 4）天。CUSUM分析得出学习曲线，以手术时间缩短来定义，LDN为23例，HARP为45例，RADN为26例。
我们的研究显示三种MIDN技术在术后并发症相同的情况下有不同的学习曲线。LDN和RADN的学习曲线比手辅助供体肾切除术的学习曲线短。我们的观察结果有助于为接受MIDN培训的学员制定教学要求提供参考。
