Defining the Learning Curve of Flexible Ureterorenoscopy and Laser Lithotripsy
Vol. 20 No. 01 (2023),
Purpose: To investigate the impact of learning curve (LC) on flexible ureterorenoscopy (f-URS).
Materials and Methods: Patients who underwent kidney stone surgery in a urology clinic from a tertiary health care institution with f-URS were enrolled in the study. Patient characteristics, the properties of kidney and kidney stones were recorded. Also, f-URS-related parameters, hospitalization time, the success of the procedure, and complications were noted. Patients were categorized equally into 4 groups, the first 20 f-URS cases in Group 1, and the last 20 f-URS cases in Group 4. Groups were compared according to patient preoperative parameters, intraoperative outcomes, success rate and complication rate.
Results: Time from the induction of anaesthesia to insertion of flexible ureterorenoscope was 18.6 min in group 1 and 17.2 min in group 2; then it significantly decreased to 15.0 min for cases 40 through 60 and 12.4 min for cases 60 through 80 (p = 0.001). Operation time in group 3 and group 4 was significantly shorter than in group 1 and group 2 (p = 0.001). Also, fluoroscopy time was significantly longer in group 1 (82.9 seconds) and reached a plateau in group 3 (50.3 seconds) and group 4 (41.7 seconds) (p = 0.001). Additionally, after the 20th case, we achieved a significantly higher success rate in comparison to the first 20 cases (65% in group 1, 85% in group 2, 85% in group 3, and 90% in group 4, p = 0.001).
Conclusion: Flexible ureterorenoscopy is a surgery that requires high technique and experience. The present study found that success of f-URS reached satisfactory levels after 20th cases. In addition, 40 cases may be enough for surgical proficiency regarding decreases in preparation time, operation time, and fluoroscopy time.
- flexible ureterorenoscopy
- learning curve
How to Cite
Knoll T, Jessen JP, Honeck P, et al. Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30 mm size. World J Urol. 2011;29:755-9
Zanetti SP, Boeri L, Catellani M, et al. Retrograde intrarenal surgery (RIRS), regular and small sized percutaneous nephrolithotomy (PCNL) in daily practice: European Association of Urology Section of Urolithiasis (EULIS) Survey. Arch Ital Urol Androl. 2016;88:212-6.
Turk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. Guidelines on urolithiasis. Arnhem: European Association of Urology; 2014.
Tepeler A, Armağan A, Akman T, et al. Impact of percutaneous renal access technique on outcomes of percutaneous nephrolithotomy. J Endourol. 2012;26(7):828-833.
Quirke K, Aydin A, Brunckhorst O,et al. Learning Curves in Urolithiasis Surgery: A Systematic Review. J Endourol. 2018 Nov;32:1008-20.
Sahan M, Sarilar O, Savun M, et al. Adopting for Supine Percutaneous Nephrolithotomy: Analyzing the Learning Curve of Tertiary Academic Center Urology Team. Urology. 2020;140:22-6.
Schermerhorn S, Christman MS, Rocco NR, et al. Learning Curve for Robotic-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection. Journal of endourology, 2021;35(10), 1483–1489.
Jang WS, Choi KH, Yang SC, Han WK. The Learning Curve for Flank Percutaneous Nephrolithotomy for Kidney Calculi: A Single Surgeon's Experience. Korean J Urol. 2011;52(4):284-288.
Rassweiler JJ, Fiedler-Hruza M. The Learning Curve for Robot-assisted Partial Nephrectomy: There is Much Beyond a Trifecta. Eur Urol. 2019;75(2):257-258.
Hisamatsu E, Sugita Y, Haruna A, Shibata R, Yoshino K. The learning curve in proximal hypospadias repair. J Pediatr Urol. 2021;17(3):330.e1-330.e6.
Ghani KR, Wolf JS Jr. What is the stone-free rate following flexible ureteroscopy for kidney stones? Nat Rev Urol. 2015;12:281-8.
Tanriverdi O, Boylu U, Kendirci M, et al. The learning curve in the training of percutaneous nephrolithotomy. Eur Urol. 2007;52: 206–11
Tomà P, Bartoloni A, Salerno S, et al. Protecting sensitive patient groups from imaging using ionizing radiation: effects during pregnancy, in fetal life and childhood. Radiol Med. 2019;124:736-44.
- Abstract Viewed: 0 times
- 7389/pdf Downloaded: 0 times