Learning curves for urological procedures: a systematic review
Learning curves for urological procedures: a systematic review
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DOI：
10.1111/bju.12315
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发表时间：
2014-10-01
影响因子：
4.5
通讯作者：
Ahmed, Kamran
中科院分区：
文献类型：
--
作者：
Abboudi, Hamid;Khan, Mohammed Shamim;Ahmed, Kamran
目的确定泌尿外科医生必须完成的病例数才能熟练掌握各种泌尿外科手术。患者和方法系统地搜索了 MEDLINE、EMBASE 和 PsycINFO 数据库，查找截至 2011 年 12 月发表的研究。其中包括与泌尿外科手术学习曲线相关的研究。两名评审员独立识别了潜在的相关文章。手术名称、统计分析、手术设置、参与者人数、结果和学习曲线结果 44 项研究描述了不同泌尿外科手术的学习曲线。开放式根治性前列腺切除术的学习曲线为 250 至 1000 例，腹腔镜根治性前列腺切除术为 200 至 750 例。据报道，机器人辅助腹腔镜前列腺切除术 (RALP) 的学习曲线最少为 40 例。机器人辅助根治性膀胱切除术的学习曲线有记录为 16-30 例。情况，取决于测量的结果变量。无论以前的腹腔镜经验如何，100 次 RALP 后，手术时间 (P = 0.008)、估计失血量 (P = 0.008) 和并发症发生率 (P = 0.042) 均显着减少。 结论 现有文献可以作为见习泌尿科医生的学习曲线指南。尽管各个外科医生的学习曲线可能有所不同，但应该就达到熟练程度的最少病例数达成共识。与定义手术能力相关的复杂性是巨大的。大多数学习曲线试验都集中在最新的手术技术上，并且缺乏与基本泌尿外科手术相关的数据。
ObjectiveTo determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures.Patient and MethodsThe MEDLINE, EMBASE and PsycINFO databases were systematically searched for studies published up to December 2011.Studies pertaining to learning curves of urological procedures were included.Two reviewers independently identified potentially relevant articles.Procedure name, statistical analysis, procedure setting, number of participants, outcomes and learning curves were analysed.ResultsForty-four studies described the learning curve for different urological procedures.The learning curve for open radical prostatectomy ranged from 250 to 1000 cases and for laparoscopic radical prostatectomy from 200 to 750 cases.The learning curve for robot-assisted laparoscopic prostatectomy (RALP) has been reported to be 40 procedures as a minimum number.Robot-assisted radical cystectomy has a documented learning curve of 16-30 cases, depending on which outcome variable is measured.Irrespective of previous laparoscopic experience, there is a significant reduction in operating time (P = 0.008), estimated blood loss (P = 0.008) and complication rates (P = 0.042) after 100 RALPs.ConclusionsThe available literature can act as a guide to the learning curves of trainee urologists. Although the learning curve may vary among individual surgeons, a consensus should exist for the minimum number of cases to achieve proficiency.The complexities associated with defining procedural competence are vast.The majority of learning curve trials have focused on the latest surgical techniques and there is a paucity of data pertaining to basic urological procedures.