Suprapubic-assisted laparoendoscopic single-site nephrectomy: analysis of learning curve in one center

Abstract

Objective To evaluate the learning curve of Suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) nephrectomy in our center. Methods From April 2013 to April 2016, 60 patients underwent SA-LESS nephrectomy performed by two associate chief physicians (group B and C, 30 patients in both groups). There were 25 males and 5 females with mean age (48.4±9.4)years in group B, and 23 males and 7 females with mean age (52.6±12.0)years in group C. Operative time, estimated blood loss, converting to conventional laparoscopy or open surgery, intra and postoperative complications in both groups were recorded , The data from both group B and C were compared with those of group A [Standard group with 30 patients who underwent SA-LESS nephrectomy performed by a skillful chief physician, 26 males and 4 females with mean age (50.8±12.3)years]. All the patients in the three groups were diagnosed with upper urinary tract calculus or ureteral stricture with severe ipsilateral hydronephrosis (no-function kidney) and a normal contralateral kidney. The sum of the Cumulative Summation(CUSUM)was also cumulated. Individual learning curve and total learning curve were established. Result All the 30 procedures in group A were successfully completed with an average operative time [(123.3±28.4)min(85~175 min)] and an average estimated blood loss[(121.7±43.1)ml(65~280 ml)]. There were 28 procedures successfully finished in group B and 29 in group C, respectively. The average operative time was [(141.7±49.4)min(90~260 min)] and the average estimated blood loss was [(165.2±81.9)ml(70~450 ml)] in group B, and the average operative time was [(133.1±33.7)min(90~235 min)]and the average estimated blood loss was [(140.0±72.3)ml(75~500 ml)] in group C. There was 1 case converted to conventional laparoscopy and 1 case converted to open surgery in group B with 4 (13.3%) complications (Satava Ⅰ 2 cases, Satava Ⅱ 1 case, Clavien-Dindo Ⅰ 1 case) in all. There was 1 case converted to conventional laparoscopy in group C with 4 (13.3%) complications (Satava Ⅰ 1 case, Satava Ⅱ 2 cases, Clavien-Dindo Ⅱ 1 case) in all. Statistical analysis showed that the number corresponding to the slope changed into negative was 15 and 11 for group B and C, respectively, and 13 was confirmed in the total learning curve. Conclusions SA-LESS nephrectomy could be feasible and safe for an experienced laparoscopic surgeon, who may master it after he finished 13 cases of SA-LESS nephrectomy. Key words: Laparoendoscopic single-site surgery; Nephrectomy; Learning curve; Cumulative summation