Study On The Learning Curve Of Retroperitoneal Laparoscopic Partial Nephrectomy

Objective:To investigate the learning curve of retroperitoneal laparoscopic partial nephrectomy.Methods:A review of the clinical data of the 1st to 55th retroperitoneal laparoscopic partial nephrectomy performed by the Department of Urology of the Three Gorges Hospital of Chongqing University from November 2018 to July 2020 by the same medical group.Cumulative sum(CUSUM)analysis was used to analyze operative time and to fit the CUSUM learning curve.The best learning curve model is filtered by R2to determine the best fit.The different phases of the learning curve was compared on estimated blood loss,thermal ischemia time,operative time,length of hospital stay,and complications.Results:The operative time decreased with the accumulation of cases.The CUSUM learning curve was best modeled as a cubic curve with the equation:0.004x3-0.591x2+19.687x-15.173,which had a higher R2 value of 0.966.The fit curve reaches its peak when the number of surgeries accumulates to 22,and the learning curve is divided into two stages using this point.The difference in age,gender,body mass index,tumor location,tumor size,and TNM stage between the two groups was not statistically significant(P>0.05);the difference in R.E.N.A.L.score between the two groups was statistically significant(P<0.05).The difference in estimated blood loss,thermal ischemia time,and operative time between the two groups was statistically significant(P<0.05);the difference in hospitalization time and complications was not statistically significant(P>0.05).Conclusion:The learning curve of retroperitoneal laparoscopic partial nephrectomy was analyzed by CUSUM analysis,and the learning curve of this procedure can be divided into the learning stage and mastery stage,with the accumulation of the number of surgical cases,the operating time gradually showed a decreasing trend,and the learning curve for retroperitoneal laparoscopic partial nephrectomy was 22 cases.