Korean J Urol.  2008 Sep;49(9):786-790.

Clinical Experiences with Performing Laparoscopic Radical Nephrectomy after a One-year Educational Program

• Jeon SH
• Seo IY
• Lim JS
• Hattori R
• Gotoh M
• Ono Y

Abstract

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.

Keyword

Nephrectomy; Laparoscopic

MeSH Terms

Carcinoma, Renal Cell
Intraoperative Complications
Laparoscopy
Learning Curve
Nephrectomy
Operative Time
Vascular System Injuries

Reference

1. Guillonneau B, Abbou CC, Doublet JD, Gaston R, Janetschek G, Mandressi A, et al. Proposal for a "European scoring system for laparoscopic operations in urology". Eur Urol. 2001. 40:2–7.

2. Parra RO, Hagood PG, Boullier JA, Cummings JM, Mehan DJ. Complications of laparoscopic urological surgery: experience at St. Louis University. J Urol. 1994. 151:681–684.

3. Tse ET, Knaus RP. Laparoscopic nephrectomy: the learning-curve experience. Can J Surg. 1994. 37:153–157.

4. Seymour NE, Gallagher AG, Roman SA, O'Brien MK, Bansal VK, Andersen DK, et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg. 2002. 236:458–464.

5. Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P. Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg. 2004. 91:146–150.

6. Bariol SV, Tolley DA. Training and mentoring in urology: the 'LAP' generation. BJU Int. 2004. 93:913–914.

7. Fabrizio MD, Tuerk I, Schellhammer PF. Laparoscopic radical prostatectomy: decreasing the learning curve using a mentor initiated approach. J Urol. 2003. 169:2063–2065.

8. Farhat W, Khoury A, Bagli D, McLorie G, El-Ghoneimi A. Mentored retroperitoneal laparoscopic renal surgery in children: a safe approach to learning. BJU Int. 2003. 92:617–620.

9. Fahlenkamp D, Rassweiler J, Fornara P, Frede T, Loening SA. Complications of laparoscopic procedures in urology: experience with 2,407 procedures at 4 German centers. J Urol. 1999. 162:765–771.

10. Matin SF. Laparoscopic approaches to urologic malignancies. Curr Treat Options Oncol. 2003. 4:373–383.

11. Raghuram S, Godbole HC, Dasgupta P. Laparoscopic nephrectomy: the new gold standard? Int J Clin Pract. 2005. 59:128–129.

12. Higashihara E, Baba S, Nakagawa K, Murai M, Go H, Takeda M, et al. Learning curve and conversion to open surgery in cases of laparoscopic adrenalectomy and nephrectomy. J Urol. 1998. 159:650–653.

13. Phillips J, Catto JW, Lavin V, Doyle D, Smith DJ, Hastie KJ, et al. The laparoscopic nephrectomy learning curve: a single centre's development of a de novo practice. Postgrad Med J. 2005. 81:599–603.

14. Gill IS, Meraney AM, Schweizer DK, Savage SS, Hobart MG, Sung GT, et al. Laparoscopic radical nephrectomy in 100 patients: a single center experience from the United States. Cancer. 2001. 92:1843–1855.

15. Burgess NA, Koo BC, Calvert RC, Hindmarsh A, Donaldson PJ, Rhodes M. Randomized trial of laparoscopic v open nephrectomy. J Endourol. 2007. 21:610–613.

16. Colombo JR Jr, Haber GP, Jelovsek JE, Nguyen M, Fergany A, Desai MM, et al. Complications of laparoscopic surgery for urological cancer: a single institution analysis. J Urol. 2007. 178:786–791.

17. Rassweiler J, Fornara P, Weber M, Janetschek G, Fahlenkamp D, Henkel T, et al. Laparoscopic nephrectomy: the experience of the laparoscopy working group of the German Urologic Association. J Urol. 1998. 160:18–21.

18. Keeley FX, Tolley DA. A review of our first 100 cases of laparoscopic nephrectomy: defining risk factors for complications. Br J Urol. 1998. 82:615–618.

19. Simon SD, Castle EP, Ferrigni RG, Lamm DL, Swanson SK, Novicki DE, et al. Complications of laparoscopic nephrectomy: the Mayo clinic experience. J Urol. 2004. 171:1447–1450.

20. Ono Y, Kinukawa T, Hattori R, Gotoh M, Kamihira O, Ohshima S. The long-term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma. J Urol. 2001. 165:1867–1870.

21. Vallancien G, Cathelineau X, Baumert H, Doublet JD, Guillonneau B. Complications of transperitoneal laparoscopic surgery in urology: review of 1,311 procedures at a single center. J Urol. 2002. 168:23–26.

22. Soulié M, Salomon L, Seguin P, Mervant C, Mouly P, Hoznek A, et al. Multi-institutional study of complications in 1085 laparoscopic urologic procedures. Urology. 2001. 58:899–903.

23. Parsons JK, Varkarakis I, Rha KH, Jarrett TW, Pinto PA, Kavoussi LR. Complications of abdominal urologic laparoscopy: longitudinal five-year analysis. Urology. 2004. 63:27–32.