Learning Curve for Endoscopic Combined Intra-Renal Surgery Using Vacuum-Assisted Device

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Education

Background:

• Limited data exists on the learning curve for endoscopic combined intra-renal surgery (ECIRS) using vacuum-assisted devices.
• Evaluating surgical learning curves is crucial for adopting new minimally invasive techniques.

Purpose of the Study:

• To provide data on the learning curve for ECIRS utilizing vacuum-assisted devices.
• To assess the number of cases required for a surgeon to achieve proficiency and excellence in this technique.

Main Methods:

• Prospective monitoring of a mentored surgeon's training in ECIRS with vacuum assistance.
• Analysis of peri-operative data using tendency lines and CUSUM analysis to evaluate learning curves.
• Inclusion of 111 patients, with a focus on complex stones (Guy's Stone Score 3 and 4).

Main Results:

• Stone-Free Rate (SFR) was 78.4%, with 52.3% of patients being tubeless.
• Proficiency in achieving trifecta outcomes was reached after 53 cases.
• Complications decreased after 17 cases, and operative time improved after 72 cases.

Conclusions:

• A surgeon can achieve proficiency in ECIRS with vacuum assistance within 17-50 cases.
• The number of procedures needed for surgical excellence remains undetermined.
• Excluding complex cases may enhance training and reduce complications during the learning phase.