Objective• To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures. Patient and Methods• The 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. Results• Forty-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. Conclusions• The 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.

This meta-analysis shows that mitral valve repair has good clinical outcomes both in-hospital and at 1 and 5 years of follow-up. Mitral valve repair should be attempted in those patients in whom sufficient valve tissue is present for reconstruction after all infectious tissue has been resected.

Artificial liver systems are used to bridge between transplantation or to allow a patient's liver to recover. They are used in patients with acute liver failure (ALF) and acute‐on‐chronic liver failure. There are five artificial systems currently in use: molecular adsorbent recirculating system (MARS), single‐pass albumin dialysis (SPAD), Prometheus, selective plasma filtration therapy, and hemodiafiltration. The aim is to compare existing data on the efficiency of these devices. A literature search was conducted using online libraries. Inclusion criteria included randomized control trials or comparative human studies published after the year 2000. A systematic review was conducted for the five individual devices with a more detailed comparison of the biochemistry for the SPAD and MARS systems. Eighty‐nine patients were involved in the review comparing SPAD and MARS. Results showed that there was an average reduction in bilirubin (−53 μmol/L in MARS and −50 μmol/L in SPAD), creatinine (−19.5 μmol/L in MARS and −7.5 μmol/L in SPAD), urea (−0.9 mmol/L in MARS and −0.75 mmol/L in SPAD), and gamma‐glutamyl transferase (−0.215 μmol/L·s in MARS and −0.295 μmol/L·s in SPAD) in both SPAD and MARS. However, there was no significant difference between the changes in the two systems. This review demonstrated that both MARS and SPAD aid recovery of ALF. There is no difference between the efficiency of MARS and SPAD. Because of the limited data, there is a need for more randomized control trials. Evaluating cost and patient preference would aid in differentiating the systems.