Should oncological cases of upper urinary system be excluded at the beginning of the laparoscopic learning curve?

Abstract

Purpose:The place of oncological cases of upper urinary system in the laparoscopic learning curve was investigated.Materials and Methods:A total of 139 patients from two different centers underwent laparoscopic operations and were included in this retrospective study.Results:Mean operative times for oncological, and non-oncological cases were 101.3 (range 60-450), and 102.7 (45-490) minutes respectively. Fourty-two (31.3 %) patients were oncological cases. In 4 oncological cases, the surgeons switched to open surgery because of massive bleeding and six (14.2 %) oncological cases required blood transfusions during peri/postoperative periods. Pulmonary embolism was observed in one oncological case. In one non-oncological case, the surgeon switched to open surgery because of intestinal perforation and 10 (9.7 %) non-oncological cases needed blood transfusions during peri/postoperative periods. In addition, some complications such as intestinal perforation (n=1), mechanical ileus (n=1), and pulmonary embolism (n=1) were observed during postoperative period. Intestinal perforation was repaired using laparoscopic (n=1) method. Mechanical ileus was approached with open surgical technique. Mean hospital stay of the patients in the oncological and non-oncological series were 4.5 (3-23) and 4.5 (3-30) days respectively.Conclusion:We think that renal oncological cases should be included in the spectrum of laparoscopic indications even at the beginning of the learning curve. Certainly, we still share the opinion that cancer cases which require highly challenging surgeries like radical cystectomy, and prostatectomy should be postponed till to gaining of higher level of experience.

How Should be the Education Before the Urological Laparoscopic Surgery?

“…The conclusion was that laparoscopy can be performed at the beginning of the learning curve for such cases. It has been emphasized that very difficult procedures such as radical cystectomy and radical prostatectomy should be performed by a surgeon who has reached a certain level of experience [2]. In our study, when we compared the results of the patient with radical nephrectomy with those of other non-oncologic patients, we observed similar results in terms of the duration of operations, hospital stays and complications.…”

“…Laparoscopic technique is a minimally invasive approach used in many surgical operations. There is a tendency toward laparoscopic surgery because it provides for shorter hospital stays, has better cosmetic results, allows patients to return more quickly to their daily lives, has a lower morbidity, reduces blood loss and postoperative pain, and its treatment results are as effective and safe as open surgery [1,2]. After transperitoneal laparoscopic nephrectomy was first performed by Clayman et al, a historical turning point in laparoscopy, laparoscopy has become the gold standard and the number of procedures has increased significantly.…”

Initial experience of laparoscopic nephrectomy for nonfunctioning kidney in Recep Tayyip Erdogan Hospital, Muzaffargarh.

“…Outcomes of the study tabulated in 7,12,13,[10][11][12][13] By Clayman and Gill, the fundamental surgical procedure for laparoscopic nephrectomy has been thoroughly documented. 3,14,15 Our analysis revealed that more cases included the right side, with a frequency of 29 (72.5%) cases, compared to 11 (27.5%) cases where the left side was involved. These findings were consistent with prior studies in that the right side was more frequently observed than the left.…”