Analysis of the Learning Curve for Laparoscopic Renal Surgeries in Children

Abstract

Purpose: To guide pediatric urologists to start laparoscopic renal surgery in children, we analyze our experience with various laparoscopic renal surgeries to highlight the surgical outcomes and the degree of completion of specific laparoscopic skills. Materials and Methods: We retrospectively analyzed 51 children who underwent laparoscopic renal surgery by a single surgeon between March 2002 and July 2008 (25 nephrectomies, 12 nephroureterectomies, 10 heminephrectomies, 3 heminephroureterectomies, and 1 heminephrectomy in a horseshoe kidney). We compared the degree of completion of specific laparoscopic skills as well as operative parameters such as operative time, estimated blood loss, and complication rate. Results: All laparoscopic renal surgeries were completed as planned without open conversions. In the nephrectomy group (nephrectomy+nephroureterectomy), the mean operative time decreased after 10 cases (239 minutes vs. 145 minutes, p<0.001). A decrease in mean estimated blood loss was also noted after 10 cases (119 vs. 32 ml, p<0.05). The complication rate decreased after 20 cases (30% vs. 4%, p<0.05). In all patients, the completion rates for specific laparoscopic skills were 98% for trocar insertion, 80% for removal of a pathological lesion, 82% for retroperitoneal insufflation, and 73% for refluxing ureterectomy and suturing. The overall completion rate increased after 18 cases (79% vs. 91%, p<0.05). Conclusions: Operative time and blood loss in pediatric laparoscopic renal surgery are rapidly improved with experience. Improvement in the complication rate and specific laparoscopic skills require more time. We recommend that pediatric urologists beginning laparoscopic surgery try complex surgeries such as heminephrectomy or heminephroureterectomy after they have surmounted the learning curve of easy surgeries such as nephrectomy or nephroureterectomy. (Korean J Urol 2009;50:380-386) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏