改良手助后腹腔镜活体供肾切取术的学习曲线。

The learning curve for modified hand-assisted retroperitoneoscopic living donor nephrectomy.

机构信息

Department of Urology, Beijing Friendship hospital, Capital Medical University, Beijing, China.

Institute of Urology, Beijing Municipal Health Commission, Beijing, China.

出版信息

BMC Urol. 2024 Sep 3;24(1):191. doi: 10.1186/s12894-024-01581-x.

DOI:10.1186/s12894-024-01581-x

PMID:39227858

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11370098/

Abstract

BACKGROUND

We aimed to introduce our modified hand-assisted retroperitoneoscopic living donor nephrectomy (HARPLDN) technique and define the learning curve.

METHODS

One hundred thirty-eight kidney donors who underwent modified HARPLDN by the same surgeon between May 2015 and March 2022 were included. A cumulative sum (CUSUM) learning curve analysis was performed with the total operation time as the study outcome.

RESULTS

In total, the mean operative time was 138.2 ± 32.1 min. The median warm ischemic time (WIT) and estimated blood loss were 90 s and 50 ml, respectively. The learning curve for the total operative time was best modeled as a second-order polynomial with the following equation: CUSUM (min) = (-0.09 case number) + (12.88 case number) - 67.77 (R = 0.7875; p<0.05). The CUSUM learning curve included the following three unique phases: phase 1 (the initial 41 cases), representing the initial learning curve; phase 2 (the middle 43 cases), representing expert competence; and phase 3 (the final 54 cases), representing mastery. The overall 6-month graft survival rate was 99.3%, with 94.9% immediate onset of graft function without delayed graft function and 0.7% ureteral complications.

CONCLUSIONS

Our modified method is safe and effective for living donor nephrectomy and has the advantages of a shorter operating time and optimized WIT. The surgeon can become familiar with the modified HARPLDN after 41 cases and effectively perform the next 97 cases.

摘要

背景

我们旨在介绍改良手助后腹腔镜活体供肾切除术（HARPLDN）技术，并定义学习曲线。

方法

纳入 2015 年 5 月至 2022 年 3 月间由同一位外科医生实施改良 HARPLDN 的 138 例供肾者。以总手术时间为研究结果，采用累积和（CUSUM）学习曲线分析。

结果

总手术时间平均为 138.2±32.1 分钟。中位热缺血时间（WIT）和估计失血量分别为 90 秒和 50 毫升。总手术时间的学习曲线最好用二次多项式拟合，方程为：CUSUM（min）=（-0.09 例数）+（12.88 例数）-67.77（R=0.7875；p<0.05）。CUSUM 学习曲线包括以下三个独特阶段：阶段 1（最初的 41 例），代表初始学习曲线；阶段 2（中间的 43 例），代表专家能力；阶段 3（最后的 54 例），代表掌握。整体 6 个月移植物存活率为 99.3%，无延迟移植物功能，立即出现移植物功能的占 94.9%，输尿管并发症占 0.7%。