Analyzing learning curve for supine percutaneous nephrolithotomy in urology resident training programme: comparative
Yusuf Arıkan1, Yavuz Onur Danacioğlu2, Deniz Noyan Özlü3
1Departmant of Urology, İzmir Tepecik Training and Research Hospital, İzmir, Türkiye. dryusufarikan@gmail.com.
Urolithiasis
|September 9, 2024
Summary
Supine percutaneous nephrolithotomy (PCNL) outcomes improve with experience. Residents gain proficiency, reducing procedure times and complications while increasing the stone-free rate (SFR) with more cases.
Area of Science:
- Urology
- Surgical Techniques
- Medical Education
Background:
- Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
- The supine PCNL technique offers an alternative positioning for this intervention.
- Understanding the learning curve is crucial for optimizing surgical training and patient outcomes.
Purpose of the Study:
- To evaluate the learning curve and proficiency of residents performing supine percutaneous nephrolithotomy (PCNL).
- To compare outcomes between junior residents, senior residents, and experienced endourologists.
- To determine the number of cases required to achieve a stable stone-free rate (SFR) and minimize complications.
Main Methods:
- Retrospective review of supine PCNL cases performed between January 2018 and January 2024.
- Patients were divided into three groups: 2-3 year residents (Group 1), 4-5 year residents (Group 2), and endourologists (Group 3).
- Outcomes analyzed included access time, fluoroscopy time, operation time, postoperative stay, need for additional treatment, stone-free rate (SFR), and complication rates.
Main Results:
- Procedure times (access, fluoroscopy, operation) decreased significantly from Group 1 to Group 3.
- Postoperative length of stay and need for additional treatment were reduced with increasing experience.
- Stone-free rate (SFR) increased significantly across the groups, with stable SFR achieved after 46-60 cases for junior residents and 31-45 cases for senior residents. Complication rates were highest in Group 1 and lowest in Group 3.
Conclusions:
- Supine PCNL demonstrates a clear learning curve, with significant improvements in efficiency and safety as experience increases.
- Junior residents require approximately 46-60 cases to achieve a stable stone-free rate, while senior residents achieve this after 31-45 cases.
- The supine PCNL technique becomes more efficient and safer with progressive experience, highlighting the importance of supervised training and case volume.
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