Department of Urology, San Bassiano Hospital, AULSS7 Pedemontana, Bassano del Grappa, Italy.
Department of Urology, Cattinara Hospital, ASUGI Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy.
Urol Int. 2023;107(4):413-421. doi: 10.1159/000528785. Epub 2023 Feb 21.
The aim of the study was to provide data related to endoscopic combined intra-renal surgery learning curve using minimally invasive techniques with vacuum-assisted devices. Minimal data exist on the learning curve for these techniques.
We conducted a prospective study monitoring the training of a mentored surgeon learning ECIRS with vacuum assistance. We use varied parameters for improvements. After collection of peri-operative data, tendency lines and CUSUM analysis were used to investigate the learning curves.
111 patients have been included. Guy's Stone Score 3 and 4 stones 51.3% of all cases. The mostly used percutaneous sheath was 16 Fr (87.3%). SFR was 78.4%. 52.3% patients were tubeless, and 38.7% achieved trifecta. High-degree complication rate was 3.6%. Operative time improved after 72 cases. We observed a decrease of complications throughout the case series, with improvement after 17 cases. In terms of trifecta, proficiency was reached after 53 cases. Proficiency seems achievable in a limited number of procedures, but results did not plateau. Higher number of cases might be necessary for excellence.
A surgeon learning ECIRS with vacuum assistance can obtain proficiency in 17-50 cases. The number of procedures required for excellence remains unclear. Exclusion of more complex cases might positively affect the training, reducing unnecessary complications.
本研究旨在提供与使用微创技术和真空辅助装置进行内镜下联合肾内手术学习曲线相关的数据。关于这些技术的学习曲线，数据很少。
我们进行了一项前瞻性研究，监测一位接受指导的外科医生使用真空辅助进行 ECIRS 培训的情况。我们使用不同的参数来进行改进。在收集围手术期数据后，使用趋势线和累积和（CUSUM）分析来研究学习曲线。
共纳入 111 例患者。所有病例中，Guy's 结石评分 3 分和 4 分的患者占 51.3%。最常使用的经皮鞘为 16Fr（87.3%）。SFR 为 78.4%。52.3%的患者为无管化，38.7%的患者达到了 trifecta。高并发症发生率为 3.6%。72 例患者后手术时间得到改善。我们观察到整个病例系列中并发症的发生率降低，在 17 例后有所改善。在 trifecta 方面，在 53 例后达到了熟练水平。在有限的几例手术中，外科医生可以获得熟练程度，但结果并没有达到稳定状态。可能需要更多的病例才能达到卓越水平。
一位接受真空辅助 ECIRS 培训的外科医生可以在 17-50 例手术中获得熟练程度。达到卓越水平所需的手术数量仍不清楚。排除更复杂的病例可能会对培训产生积极影响，减少不必要的并发症。
