The learning curve for retrograde intrarenal surgery: A prospective analysis

Area of Science:

• Urology
• Surgical Education
• Nephrolithiasis Management

Background:

• Retrograde intrarenal surgery (RIRS) is an increasingly utilized technique for kidney stone treatment.
• The learning curve for RIRS is not well-defined, hindering standardized training.
• Establishing proficiency benchmarks is crucial for safe and effective RIRS implementation.

Purpose of the Study:

• To determine the number of RIRS procedures required for a urology resident to achieve consistent proficiency.
• To quantitatively and qualitatively analyze the learning curve associated with RIRS.

Main Methods:

• Analysis of the first 80 RIRS procedures performed by a single urology resident.
• Procedures were divided into four groups (20 surgeries each) for comparative analysis.
• Evaluation of quantitative (operative times) and qualitative surgical variables.

Main Results:

• Significant improvements in qualitative variables were observed across the first three groups.
• Quantitative improvements noted in double-J catheter placement time and total operative time.
• Stone-free status remained consistent throughout the learning process, indicating safety.

Conclusions:

• Proficiency in RIRS is directly related to the number of procedures performed.
• Approximately 60 RIRS procedures are sufficient to reach the plateau of the learning curve.
• Sequential optimization of surgical parameters occurs with increasing experience.