Retroperitoneal Laparoscopic Nephrectomy: The Effect of the Learning Curve, and Concentrating Expertise, on Operating Times

Skinner, Adrian; Maoate, Kiki; Beasley, Spencer W.

doi:10.1089/lap.2009.0364

Cited by 14 publications

(8 citation statements)

References 6 publications

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“…In the early 2000s, members of our breast surgical staff proposed and implemented an alternative BM-technique involving two attending surgeons. Although a two-surgeon model has been advocated in other surgical subspecialties for a small subset of cases including orthopedics [13, 14], urology [15–17], thoracics [12] and hepatobiliary surgery [11], to the best of our knowledge it has not been integrated or evaluated in a breast surgical context.…”

Section: Discussionmentioning

confidence: 99%

Does “Two is Better Than One” Apply to Surgeons? Comparing Single-Surgeon Versus Co-surgeon Bilateral Mastectomies

et al. 2015

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Background Bilateral mastectomies (BM) are traditionally performed by single surgeons (SS); a co-surgeon (CS) technique, where each surgeon concurrently performs a unilateral mastectomy, offers an alternative approach. We examined differences in general surgery time (GST), overall surgery time (OST), and patient complications for BM performed by CS and SS. Methods Patients undergoing BM with tissue expander reconstruction (BMTR) between January 2010 and May 2014 at our center were identified through operative case logs. GST (incision to end of BM procedure), reconstruction duration (RST) (plastic surgery start to end of reconstruction) and OST (OST= GST + RST) was calculated. Patient age, presence/stage of cancer, breast weight, axillary-procedure performed, and 30-day postoperative complications were extracted from medical records. Differences in GST and OST between CS- and SS-cases were assessed with a t-test. A multivariate linear regression was fit to identify factors associated with GST. Results 116 BMTR cases were performed [CS, n=67 (57.8%); SS, n=49 (42.2%)]. Demographic characteristics did not differ between groups. GST and OST were significantly shorter for CS-cases, 75.8 vs. 116.8 minutes, p<0.0001, and 255.2 vs. 278.3 minutes, p=0.005, respectively. Presence of a CS significantly reduces BMTR time (β=−38.82, p<0.0001). Breast weight (β=0.0093, p=0.03) and axillary dissection (β=28.69, p=0.0003) also impacted GST. Conclusions The co-surgeon approach to BMTR reduced both GST and OST, however the degree of time-savings (35.1% and 8.3% respectively) was less than hypothesized. A larger study is warranted to better characterize time, cost, and outcomes of the CS-approach for BM.

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Section: Discussionmentioning

confidence: 99%

Does “Two is Better Than One” Apply to Surgeons? Comparing Single-Surgeon Versus Co-surgeon Bilateral Mastectomies

et al. 2015

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“…These authors also noted that anatomical factors, such as a grossly dilated kidney, could increase operative times significantly. [ 18 ]…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic retroperitoneoscopic nephrectomy and partial nephrectomy in children

Alhazmi

Farraj

2015

Urol Ann

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Objectives:The aim was to evaluate our experience in the retroperitoneal laparoscopic approach in total and partial nephrectomies in children.Materials and Methods:We retrospectively reviewed the medical records of 41 patients who underwent retroperitoneal laparoscopic total or partial nephrectomies performed in our center from 2004 to 2012. We looked at the demographic data, age at surgery, indication, operative time, surgical complications, conversion to open surgery and operative complications.Results:Thirty-five total and six partial nephrectomies (upper pole) were performed. The mean age was 84 months (7-175). Vesicoureteric reflux, pelviureteric junction obstruction, and multicystic dysplastic kidney disease were the main underlying pathologies.The mean operative time was 158 min (60-280). There were no intraoperative complications (surgical and anesthetic), and no significant blood loss was observed. Conversion to open surgery was necessary in two cases caused by failure to progress due to difficult anatomy during the partial nephrectomies. No major postoperative complications were noted. The mean hospital stay was 2.5 days (1-5). A drain was used in 12 cases and was removed after a mean of 2 days.Conclusions:Laparoscopic retroperitoneoscopic renal surgery can be carried out safely and effectively in children. Still, this procedure is more challenging and requires an excellent image of the retroperitoneal space, especially when partial nephrectomies are concerned.

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“…Each of this technique presents advantages and disadvantages and the surgical skills of the surgeon with the learning curve play a pivotal role. [ 7 ]…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic upper pole heminephroureterectomy in children: Seven-year experience

Marte¹,

Papparella²,

Pintozzi³

2015

Afr J Paediatr Surg

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Background:Minimally invasive surgery is the current approach to perform heminephroureterectomy (HN) in children. This can be obtained through a transperitoneal (TP) or a retroperitoneal approach. Here, we report our experience using a TP approach.Materials and Methods:From 2005 to 2014, 22 TP laparoscopic upper poles HN were performed at our institution. There were nine girls and 13 boys aged between 20 months and 6 years (mean age 3.9). Eight patients were diagnosed prenatally, 17 patients presented with urinary tract infection (UTI) and three with vomiting and failure to thrive. The indication for HN was reflux nephropathy and UTI in non-functioning upper pole in 19 patients and cystic dysplasia in 1 patient. The surgical technique involved the following steps: Cystoscopic recognition; positioning of 3-4 trocar (right HN); identification of the kidney (detachment of the colon); isolation and low ligation of the dilated ureter; decrossing from renal vessels; section of the parenchyma by LigaSure; haemostasis with clips and LigaSure; drain.Results:The mean operative time was 154 min (range: 81-220 min). All patients were discharged from the 2nd to 4th day. Neither major complication nor conversion was recorded. 1 patient presented leakage of urine for 7 days from the drainage which resolved spontaneously. At ultrasound follow-up, 5 patients showed a secondary perirenal cyst, 2-5 cm diameter that resolved spontaneously.Conclusion:The results indicate that laparoscopic upper pole heminephrectomy is the treatment of choice in cases of non-functioning dilated lower segments of duplicated kidneys. The use of laparoscopic approach offers a good working space, a good visual control of the vessels and allows a very low isolation of the ureteral stump which counterbalance the peritoneal violation.

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Retroperitoneal Laparoscopic Nephrectomy: The Effect of the Learning Curve, and Concentrating Expertise, on Operating Times

Cited by 14 publications

References 6 publications

Does “Two is Better Than One” Apply to Surgeons? Comparing Single-Surgeon Versus Co-surgeon Bilateral Mastectomies

Does “Two is Better Than One” Apply to Surgeons? Comparing Single-Surgeon Versus Co-surgeon Bilateral Mastectomies

Laparoscopic retroperitoneoscopic nephrectomy and partial nephrectomy in children

Laparoscopic upper pole heminephroureterectomy in children: Seven-year experience

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