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KMID : 0358320080490090786
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Korean Journal of Urology
2008 Volume.49 No. 9 p.786 ~ p.790
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Clinical Experiences with Performing Laparoscopic Radical Nephrectomy after a One-year Educational Program
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Jeon Seung-Hyun
Seo Ill-Young
Lim Jae-Sung
Hattor Ryohei
Gotoh Momokazu
Ono Yoshinari
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Abstract
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Purpose: Laparoscopic radical nephrectomy is a standard treatment for localized renal cell carcinoma. Although it is less invasiveness than open surgery, it has a steeper learning curve compared with open surgery. We analyzed the results of laparosopic radical nephrectomy that was performed by 3 surgeons who had finished a 1-year laparoscopy educational program.
Materials and Methods: A total of 103 cases of laparoscopic radical nephrectomy that were performed from June 2003 to July 2007 were enrolled in this study. These cases were performed via a transperitoneal, pure laparoscopic approach. We analyzed each surgeon’s operative time, their operative blood loss and the complication rate, and then we examined a sequential transition after dividing the cases into three groups.
Results: The average tumor size was 4.69±2.21cm. The tumor stage distribution was T1 in 74 cases, T2 in 14 cases, T3a in 13 cases and T3b in 2 cases. The average operative time and calculated operative blood loss were 211.6±73.4 min and 553.6±466.9ml, respectively. Intraoperative complications occurred in 13 cases(12.6%). There were 2 cases of open conversion due to vascular injury. Surgeon A did a total of 50 cases during 4 years and his average operative time and estimated blood loss 170.8± 61.7 min and 577.4±457.5ml, respectively. Surgeon B did a total of 29 cases during 3 years and his results were 259±74.8 min and 434.8±468.1ml, respectively. Surgeon C did 24 cases during 2 years and his results were 239.1±45.5 min and 604.3±489.7ml, respectively. Sequential analysis of each surgeon’s data after dividing the cases into three groups showed that operative time decreased significantly for surgeons A & B. However, the operative blood loss and complication rates did not significantly differ.
Conclusions: This intensified 1-year educational program was successful enough to allow an inexperienced surgeon to complete laparoscopic radical nephrectomy without supervision.
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KEYWORD
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Nephrectomy, Laparoscopic
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