Choi Chang In, Lee Kyeong Jun, Kim Min Joo, Park Jae-Kyun, Kim Da Woon, Kim Hyo Jin, Rhee Harin, Song Sang Heon, Seong Eun Young, Kim Dae-Hwan, Jeon Tae Yong, Jung Hyuk Jae
Department of Surgery, Pusan National University School of Medicine, Busan, Korea.
Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Ann Surg Treat Res. 2024 Aug;107(2):81-90. doi: 10.4174/astr.2024.107.2.81. Epub 2024 Jul 30.
This study aims to analyze the learning curve of hand-assisted laparoscopic living donor nephrectomy (HLDN) conducted by a trained gastrointestinal surgeon.
A retrospective analysis was performed on the perioperative clinical data of 96 consecutive patients who underwent HLDN from May 2013 to March 2023. The learning curve was evaluated using the cumulative sum (CUSUM) test based on operation time and risk-adjusted CUSUM for postoperative complications. Patients were divided into three groups (novice, development, and competency phases) based on changes in operation time. Patient demographics and perioperative outcomes were compared between each group.
Among the patients, 35 were male, with a mean age of 48.9 ± 11.3 years and a mean body mass index (BMI) of 24.5 ± 3.2 kg/m. The novice phase (phase 1) included the first 30 cases, with the development phase (phase 2) up to the 65th case. Operation times were significantly different across phases, averaging 263.2 ± 33.4, 211.1 ± 34.4, and 161.1 ± 31.3 minutes for phases 1, 2, and 3, respectively (P < 0.001). Blood loss decreased gradually across phases (phase 1, 264.7 ± 144.4 mL; phase 2, 239.7 ± 166.3 mL; phase 3, 198.8 ± 103.5 mL), though not statistically significant. BMI impacted operation time only in phase 1. Overall postoperative complications occurred in 13 cases (Clavien-Dindo grade I, 4 cases; grade II, 9 cases), with no significant differences across phases.
HLDN can be safely performed by a trained gastrointestinal surgeon, with approximately 30 cases needed to achieve proficiency.
本研究旨在分析由训练有素的胃肠外科医生实施的手辅助腹腔镜活体供肾切除术（HLDN）的学习曲线。
对2013年5月至2023年3月期间连续96例行HLDN患者的围手术期临床资料进行回顾性分析。基于手术时间和术后并发症的风险调整累积和（CUSUM）检验评估学习曲线。根据手术时间变化将患者分为三组（新手期、进展期和胜任期）。比较各组患者的人口统计学特征和围手术期结局。
患者中，男性35例，平均年龄48.9±11.3岁，平均体重指数（BMI）为24.5±3.2kg/m²。新手期（第1阶段）包括前30例，进展期（第2阶段）至第65例。各阶段手术时间差异有统计学意义，第1、2、3阶段平均分别为263.2±33.4、211.1±34.4和161.1±31.3分钟（P<0.001）。各阶段失血量逐渐减少（第1阶段，264.7±144.4mL；第2阶段，239.7±166.3mL；第3阶段，198.8±103.5mL），但差异无统计学意义。BMI仅在第1阶段影响手术时间。术后总体并发症13例（Clavien-Dindo分级I级4例；II级9例），各阶段差异无统计学意义。
训练有素的胃肠外科医生可安全实施HLDN，达到熟练水平大约需要30例手术。
