Laparoendoscopic single-site surgery for the treatment of different urological pathologies: Defining the learning curve of an experienced laparoscopist

Objectives: To define the learning curve of laparoendoscopic single-site surgery (LESS) of an experienced laparoscopist. Patients and methods: Patients who had LESS, since its implementation in December 2009 until December 2014, were retrospectively analysed. Procedures were divided into groups of 1...

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Autores principales:	Aly M. Abdel-Karim, Ibrahim M. Elhenawy, Ahmed A. Eid, Elsayed Yahia, Salah A. Elsalmy
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2017
Materias:	Laparo-endoscopic single-site surgery Learning curve LESS Single port Urology Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/b6c8780024d24c8d9d6ab5bc6de54e22
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spelling	oai:doaj.org-article:b6c8780024d24c8d9d6ab5bc6de54e222021-12-02T10:50:51ZLaparoendoscopic single-site surgery for the treatment of different urological pathologies: Defining the learning curve of an experienced laparoscopist2090-598X10.1016/j.aju.2017.06.001https://doaj.org/article/b6c8780024d24c8d9d6ab5bc6de54e222017-09-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2090598X17300724https://doaj.org/toc/2090-598XObjectives: To define the learning curve of laparoendoscopic single-site surgery (LESS) of an experienced laparoscopist. Patients and methods: Patients who had LESS, since its implementation in December 2009 until December 2014, were retrospectively analysed. Procedures were divided into groups of 10 and scored according to the European Scoring System for Laparoscopic Operations in Urology. Different LESS indications were done by one experienced laparoscopist. Technical feasibility, surgical safety, outcome, as well as the number of patients required to achieve professional competence were assessed. Results: In all, 179 patients were included, with mean (SD) age of 36.3 (17.5) years and 25.4% of the patients had had previous surgeries. Upper urinary tract procedures were done in 65.9% of patients and 54.7% of the procedures were extirpative. Both transperitoneal and retroperitoneal LESS were performed in 92.8% and 7.2% of the patients, respectively. The intraoperative and postoperative complication rates were 2.2% and 5.6% (Clavien–Dindo Grade II 3.9% and IIIa 1.7%), respectively. In all, 75% of intraoperative complications and all conversions were reported during the first 30 LESS procedures; despite the significantly higher difficulty score in the subsequent LESS procedures. One 5-mm extra port, conversion to conventional laparoscopy and open surgery was reported in 14%, 1.7%, and 1.1% of the cases, respectively. At mean (SD) follow-up of 39.7 (11.4) months, all the patients that underwent reconstructive LESS procedures but one were successful. Conclusion: In experienced hands, at least 30 LESS procedures are required to achieve professional competence. Although difficult, both conversion and complication rates of LESS are low in experienced hands.Aly M. Abdel-KarimIbrahim M. ElhenawyAhmed A. EidElsayed YahiaSalah A. ElsalmyTaylor & Francis GrouparticleLaparo-endoscopic single-site surgeryLearning curveLESSSingle portUrologyDiseases of the genitourinary system. UrologyRC870-923ENArab Journal of Urology, Vol 15, Iss 3, Pp 187-193 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Laparo-endoscopic single-site surgery Learning curve LESS Single port Urology Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Laparo-endoscopic single-site surgery Learning curve LESS Single port Urology Diseases of the genitourinary system. Urology RC870-923 Aly M. Abdel-Karim Ibrahim M. Elhenawy Ahmed A. Eid Elsayed Yahia Salah A. Elsalmy Laparoendoscopic single-site surgery for the treatment of different urological pathologies: Defining the learning curve of an experienced laparoscopist
description	Objectives: To define the learning curve of laparoendoscopic single-site surgery (LESS) of an experienced laparoscopist. Patients and methods: Patients who had LESS, since its implementation in December 2009 until December 2014, were retrospectively analysed. Procedures were divided into groups of 10 and scored according to the European Scoring System for Laparoscopic Operations in Urology. Different LESS indications were done by one experienced laparoscopist. Technical feasibility, surgical safety, outcome, as well as the number of patients required to achieve professional competence were assessed. Results: In all, 179 patients were included, with mean (SD) age of 36.3 (17.5) years and 25.4% of the patients had had previous surgeries. Upper urinary tract procedures were done in 65.9% of patients and 54.7% of the procedures were extirpative. Both transperitoneal and retroperitoneal LESS were performed in 92.8% and 7.2% of the patients, respectively. The intraoperative and postoperative complication rates were 2.2% and 5.6% (Clavien–Dindo Grade II 3.9% and IIIa 1.7%), respectively. In all, 75% of intraoperative complications and all conversions were reported during the first 30 LESS procedures; despite the significantly higher difficulty score in the subsequent LESS procedures. One 5-mm extra port, conversion to conventional laparoscopy and open surgery was reported in 14%, 1.7%, and 1.1% of the cases, respectively. At mean (SD) follow-up of 39.7 (11.4) months, all the patients that underwent reconstructive LESS procedures but one were successful. Conclusion: In experienced hands, at least 30 LESS procedures are required to achieve professional competence. Although difficult, both conversion and complication rates of LESS are low in experienced hands.
format	article
author	Aly M. Abdel-Karim Ibrahim M. Elhenawy Ahmed A. Eid Elsayed Yahia Salah A. Elsalmy
author_facet	Aly M. Abdel-Karim Ibrahim M. Elhenawy Ahmed A. Eid Elsayed Yahia Salah A. Elsalmy
author_sort	Aly M. Abdel-Karim
title	Laparoendoscopic single-site surgery for the treatment of different urological pathologies: Defining the learning curve of an experienced laparoscopist
title_short	Laparoendoscopic single-site surgery for the treatment of different urological pathologies: Defining the learning curve of an experienced laparoscopist
title_full	Laparoendoscopic single-site surgery for the treatment of different urological pathologies: Defining the learning curve of an experienced laparoscopist
title_fullStr	Laparoendoscopic single-site surgery for the treatment of different urological pathologies: Defining the learning curve of an experienced laparoscopist
title_full_unstemmed	Laparoendoscopic single-site surgery for the treatment of different urological pathologies: Defining the learning curve of an experienced laparoscopist
title_sort	laparoendoscopic single-site surgery for the treatment of different urological pathologies: defining the learning curve of an experienced laparoscopist
publisher	Taylor & Francis Group
publishDate	2017
url	https://doaj.org/article/b6c8780024d24c8d9d6ab5bc6de54e22
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Laparoendoscopic single-site surgery for the treatment of different urological pathologies: Defining the learning curve of an experienced laparoscopist

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