TY - JOUR
T1 - Learning curve or experience-related outcome: What really matters in paediatric laparoscopic pyeloplasty
AU - Panek, Wojciech
AU - Szmer, Jakub
AU - Kuijper, Caroline F.
AU - Chrzan, Rafal
N1 - Publisher Copyright: © Creative Commons licenses: This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY -NC -SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Introduction: The process of improving one's skills over time is called a “learning curve”. This term has attracted great attention during the last decades, especially in relation to laparoscopic techniques. Aim: To assess the outcome of paediatric laparoscopic pyeloplasty (LP). Material and methods: Retrospective analysis of the consecutive LPs. The inclusion criteria: (1) children aged < 18 years, (2) transperitoneal approach, and (3) the same operating paediatric urologist (RC). Patients with a history of any procedure on the upper urinary tract were excluded. Any surgical reintervention during follow-up was defined as a failure. The outcomes of LPs performed before 2012 (G1) were compared to those conducted between 2012 and 2016 (G2). Fisher's exact test was used for statistical analysis. Results: Ninety patients met the inclusion criteria, and a total of 95 LPs were performed. The mean operation time was 155 min, and the mean hospitalisation period was 2.4 days. In G1, 19 patients underwent Anderson-Hynes LP, 16 had Fenger non-dismembered LP and two underwent vascular hitch. In G2, 54, 2 and 2 patients underwent these procedures, respectively. The overall success rate was 91.5%. There were six failures in G1 and three in G2 (p = 0.147). Of the Anderson-Hynes LPs, 1/19 in G1 and 3/58 in G2 required reintervention (p = 1). For Fenger LPs, this was 4/16 and 0/2, respectively (p = 1). Only one patient required reoperation after vascular hitch. Conclusions: The surgeons' learning curve reflects their experience with regard to the entire therapeutic process, but not exclusively their manual skills.
AB - Introduction: The process of improving one's skills over time is called a “learning curve”. This term has attracted great attention during the last decades, especially in relation to laparoscopic techniques. Aim: To assess the outcome of paediatric laparoscopic pyeloplasty (LP). Material and methods: Retrospective analysis of the consecutive LPs. The inclusion criteria: (1) children aged < 18 years, (2) transperitoneal approach, and (3) the same operating paediatric urologist (RC). Patients with a history of any procedure on the upper urinary tract were excluded. Any surgical reintervention during follow-up was defined as a failure. The outcomes of LPs performed before 2012 (G1) were compared to those conducted between 2012 and 2016 (G2). Fisher's exact test was used for statistical analysis. Results: Ninety patients met the inclusion criteria, and a total of 95 LPs were performed. The mean operation time was 155 min, and the mean hospitalisation period was 2.4 days. In G1, 19 patients underwent Anderson-Hynes LP, 16 had Fenger non-dismembered LP and two underwent vascular hitch. In G2, 54, 2 and 2 patients underwent these procedures, respectively. The overall success rate was 91.5%. There were six failures in G1 and three in G2 (p = 0.147). Of the Anderson-Hynes LPs, 1/19 in G1 and 3/58 in G2 required reintervention (p = 1). For Fenger LPs, this was 4/16 and 0/2, respectively (p = 1). Only one patient required reoperation after vascular hitch. Conclusions: The surgeons' learning curve reflects their experience with regard to the entire therapeutic process, but not exclusively their manual skills.
KW - Children
KW - Laparoscopy
KW - Learning curve
KW - Pyeloplasty
UR - http://www.scopus.com/inward/record.url?scp=85086245277&partnerID=8YFLogxK
U2 - https://doi.org/10.5114/wiitm.2019.89391
DO - https://doi.org/10.5114/wiitm.2019.89391
M3 - Article
C2 - 32489500
SN - 1895-4588
VL - 15
SP - 377
EP - 381
JO - Wideochirurgia I Inne Techniki Maloinwazyjne
JF - Wideochirurgia I Inne Techniki Maloinwazyjne
IS - 2
ER -