Zoeir Ahmed, Mamdoh Hussein, Moussa Ayman, Abdel-Raheem Ali, Gameel Tarek, Elsherbeny Ahmed, Al Debeiky Abdullah, Almekaty Khaled, Ragab Maged, Tawfik Ahmed, Puliatti Stefano, Ferretti Stefania, Micali Salvatore, Proietti Silvia, Oo Mon Mon, Giusti Guido, Elashry Osama, Elbahnasy Abdelhamid, Sabaa Magdy, Abo El-Enen Mohamed, Bianchi Giampaolo, Eissa Ahmed
Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt -
Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Minerva Urol Nephrol. 2024 Dec;76(6):748-758. doi: 10.23736/S2724-6051.24.05974-3.
Percutaneous nephrolithotomy (PCNL) could be performed in both prone and supine positions. Each position has its own advantages and disadvantages. "Learning curve" is a graph that represents progress of a skill against the time needed to master the technique. We hypothesized that supine PCNL might have a shorter learning curve by novice urologists compared to prone PCNL based on the findings of previous studies assessing the learning curve of both techniques. The aim of this study is to assess the learning curve of prone and supine PCNL among novice urologists to detect which is easier for the beginners.
One hundred and fifty patients undergoing PCNL for renal stones were included and divided into two groups; Group A included 75 patients undergoing supine PCNL and Group B included 75 patients undergoing prone PCNL. Subsequently, each group was subdivided into three subgroups of 25 patients to allow the evaluation of the learning curve of the two novice surgeons as regards: operative time, fluoroscopy time, stone free rate, and complications.
The mean operative time in group A decreased from of 111.8±13.91 minutes to 84.2±15.86 minutes, and thereafter, decreased to 78.4±12.97 minutes in the three consecutive subgroups. Similarly, in group B, the mean operative time decreased from 122±23.76 minutes to 110.2±17.05 minutes, and thereafter, further decreased to 82±15.34 minutes. The operative time plateau was reached after 25 and 50 cases in groups A and B, respectively. The overall stone free rate, and complications were comparable in both groups.
Both supine and prone PCNL are safe and effective; however, supine PCNL may be associated with significantly shorter learning curve.
经皮肾镜取石术（PCNL）可在俯卧位和仰卧位下进行。每种体位都有其自身的优缺点。“学习曲线”是一种表示技能进步与掌握该技术所需时间关系的图表。基于之前评估两种技术学习曲线的研究结果，我们假设与俯卧位PCNL相比，新手泌尿外科医生进行仰卧位PCNL的学习曲线可能更短。本研究的目的是评估新手泌尿外科医生进行俯卧位和仰卧位PCNL的学习曲线，以确定哪种对初学者更容易。
纳入150例因肾结石接受PCNL的患者，并分为两组；A组包括75例接受仰卧位PCNL的患者，B组包括75例接受俯卧位PCNL的患者。随后，每组再分为三个亚组，每组25例患者，以便评估两位新手外科医生在手术时间、透视时间、结石清除率和并发症方面的学习曲线。
A组的平均手术时间从111.8±13.91分钟降至84.2±15.86分钟，此后，在连续的三个亚组中降至78.4±12.97分钟。同样，B组的平均手术时间从122±23.76分钟降至110.2±17.05分钟，此后进一步降至82±15.34分钟。A组和B组分别在25例和50例手术后达到手术时间平台期。两组的总体结石清除率和并发症相当。
仰卧位和俯卧位PCNL均安全有效；然而，仰卧位PCNL的学习曲线可能明显更短。
