Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada.
Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
Int Urol Nephrol. 2022 Aug;54(8):1857-1863. doi: 10.1007/s11255-022-03229-x. Epub 2022 May 19.
The learning curves for minimally invasive pyeloplasty techniques have been described in the past. However, the learning curve in achieving competency in open pyeloplasty has not been described. Hence, we aim to evaluate a single surgeon series of open pyeloplasty technique using the cumulative sum (CUSUM) methodology.
We retrospectively reviewed all open pyeloplasties performed by a single surgeon (AJL) between January 2008 and March 2020. Collected variables included: sex, age at surgery, operative time, hospital stay, pre-operative ultrasound, pre-operative nuclear scans, pre-operative anteroposterior diameter, associated anomalies, laterality (left or right), type of stent, pre-operative split renal function, and duration of follow-up. A CUSUM analysis was used: the highest peak, plateau and downward trends for complications (defined as Clavien-Dindo classification ≥ 3b) were identified on the plot and set as the transition points between five phases (learning, competency, proficiency, case-mix, and mastery).
Based on the CUSUM analysis, the index surgeon reached the competency phase after performing their 13th open pyeloplasty and became proficient after the 70th case. In the case-mix phase (104th-126th cases), where the surgeon may be performing more complex cases while increasing trainee involvement, there was a slight increase in complication rates. After the 126th case, the surgeon entered the mastery phase, where there was consistent decreasing trend in complications.
Surgeons performing open pyeloplasty in children following completion of their surgical training will continue to learn through their early cases until achieving competency. Technical competency may be reached after the 13th case. In this report, we looked at the number of cases to become proficient in open pyeloplasty procedure in children. A surgeon may achieve technical proficiency in the procedure after their 13th case.
过去已经描述了微创肾盂成形术技术的学习曲线。然而，在开放式肾盂成形术中达到熟练程度的学习曲线尚未描述。因此，我们旨在使用累积和（CUSUM）方法评估一位外科医生的一系列开放式肾盂成形术技术。
我们回顾性分析了 2008 年 1 月至 2020 年 3 月期间由一位外科医生（AJL）进行的所有开放式肾盂成形术。收集的变量包括：性别、手术时的年龄、手术时间、住院时间、术前超声、术前核扫描、术前前后径、相关异常、侧别（左或右）、支架类型、术前分肾功能和随访时间。使用 CUSUM 分析：在图上确定并发症（定义为 Clavien-Dindo 分类≥3b）的最高峰值、平台和下降趋势，并将其作为五个阶段（学习、熟练、精通、病例组合和掌握）之间的转换点。
根据 CUSUM 分析，该主刀医生在完成第 13 例开放式肾盂成形术后达到熟练阶段，在第 70 例病例后达到精通阶段。在病例组合阶段（第 104 例至第 126 例），外科医生可能会进行更复杂的病例，同时增加学员的参与度，并发症发生率略有上升。在第 126 例病例后，外科医生进入掌握阶段，并发症呈持续下降趋势。
在完成外科培训后，在儿童中进行开放式肾盂成形术的外科医生将继续通过早期病例学习，直到达到熟练程度。技术熟练可能在第 13 例病例后达到。在本报告中，我们研究了在儿童中达到熟练程度的开放式肾盂成形术病例数量。外科医生可能在第 13 例病例后在该手术中达到技术熟练程度。
