Complications of Flexible Ureteroscopic Treatment for Renal and Ureteral Calculi during the Learning Curve

2015 ◽  
Vol 95 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Masatsugu Komori ◽  
Hirofumi Izaki ◽  
Kei Daizumoto ◽  
Megumi Tsuda ◽  
Yoshito Kusuhara ◽  
...  
Keyword(s):  
Learning Curve ◽  
Complication Rate ◽  
Operation Time ◽  
Complication Rates ◽  
Training Experience ◽  
Therapeutic Benefits ◽  
Stone Free Rate ◽  
Surgeon Experience ◽  
The Mean ◽  
Free Rate

Background: The flexible ureterorenoscope (URS) and associated devices have developed rapidly. However, despite its therapeutic benefits, URS may be associated with some complications. To the best of our knowledge, there are no studies discussing the complications of flexURS during the learning curve. Methods: A retrospective review of the records of patients who underwent flexURS from January 2005 to June 2013 was performed. To compare the complications after the introduction of flexURS, patients were divided into four groups based on the surgeon's training experience, that is, based on the number of cases performed by the surgeon. A total of 219 cases underwent flexURS. Groups 1, 2, 3, and 4 included 35, 50, 50, and 84 cases, respectively. The complications were classified using the Clavien system (I-IV). Results: The mean operation time and stone-free rate were significantly different (p < 0.001, p = 0.013, respectively). The total complication rates were 13.6, 10, 8.3, and 3.2%, respectively (p = 0.068). The more the surgeon's experience, the less was the complication rate. Despite our best efforts, the incidence of urosepsis was not reduced (p = 0.902). Conclusions: To reduce severe complications, it is necessary to have performed about 100 cases. Increased surgeon experience tended to decrease the risk of severe complications, but the incidence of urosepsis was not reduced.

scholarly journals TRANSITION FROM PRONE TO SUPINE PERCUTANEOUS NEPHROLITOTOMY: EVALUATING THE LEARNING CURVE FROM THE SINGLE SURGEON EXPERIENCE

2021 ◽  
Vol 28 (2) ◽  
pp. 147-152
Author(s):  
Zulfikar Ali ◽  
Andika Afriansyah
Keyword(s):  
Learning Curve ◽  
Hospital Stay ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Major Complication ◽  
Hemoglobin Level ◽  
Stone Free Rate ◽  
Surgeon Experience ◽  
The Mean ◽  
Free Rate

Objective: This study aims to evaluate the learning curve of the urologist to perform supine PCNL and the perioperative outcome of patients based on a single surgeon’s experience. Material & Methods: 60 consecutive patients who underwent modified supine PCNL for renal stone were analyzed. A single experienced urological surgeon performed the supine PCNL. Mean operative time, drop in hemoglobin level, stone-free rate, complications, and length of hospital stay were analyzed to evaluate the learning curve of the surgeon. All parameters were compared among all six groups obtained from the 60 cases in chronological order. Besides, the outcomes of supine PCNL were also compared to prone PCNL. Results: Mean operative time from 60 cases of supine PCNL was 100 ± 27 minutes. The mean operative time was decreased over time, particularly after 20 cases. Significantly different mean operative times (89 ± 14 minutes vs. 126 ± 21 minutes, p < 0.001) in the groups of cases 21-60 compared to the group of 1–20 cases were observed. The total stone-free rate for supine PCNL from all cases was 68%. There was no difference regarding the reduction of hemoglobin level, stone-free rate, hospital stay, and complication rate. No major complication was found among study subjects. Supine PCNL showed similar outcome parameters compared to prone PCNL. Conclusion: The surgeon acquired the surgical competencies to perform supine PCNL after 20 cases. The supine PCNL could remove the kidney stone as effective and safe as prone PCNL.

scholarly journals Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 231
Author(s):  
Ponco Birowo ◽  
William Tendi ◽  
Indah S. Widyahening ◽  
Nur Rasyid ◽  
Widi Atmoko
Keyword(s):  
Hospital Stay ◽  
Prone Position ◽  
Percutaneous Nephrolithotomy ◽  
Complication Rate ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Major Complication ◽  
Stone Free Rate ◽  
Major Complication Rate ◽  
Free Rate

Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 – 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 – 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon’s experience and clinical aspects of the patients.

scholarly journals Comparison of Ultrasound-assisted and Pure Fluoroscopy-guided Extracorporeal Shockwave Lithotripsy for Renal Stones

2020 ◽  
Author(s):  
Tsung-Hsin Chang ◽  
Wun-Rong Lin ◽  
Wei-Kung Tsai ◽  
Pai-Kai Chiang ◽  
Marcelo Chen ◽  
...  
Keyword(s):  
Complication Rate ◽  
Renal Stones ◽  
Complication Rates ◽  
Disintegration Rate ◽  
Stone Size ◽  
Stone Free Rate ◽  
The Usa ◽  
Retreatment Rate ◽  
Ultrasound Assisted ◽  
Free Rate

Abstract Background: In this study, we aimed to compare the efficacy and clinical outcomes of shock wave lithotripsy (SWL) for patients with renal stones using pure fluoroscopy (FS) or ultrasound-assisted (USa) localization with two lithotripters.Methods: We retrospectively identified 425 patients with renal calculi who underwent SWL with either a LiteMed LM-9200 ELMA lithotripter (209 cases), which combined ultrasound and fluoroscopic stone targeting or a Medispec EM-1000 lithotripter machine (216 cases), which used fluoroscopy for stone localization and tracking. The patient demographic data, stone-free rates, stone disintegration rates, retreatment rates and complication rates were analyzed.Results: The USa group had a significantly higher overall stone-free rate (43.6 vs. 28.2%, p<0.001) and stone disintegration rate (85.6 vs. 64.3%, p<0.001), as well as a significantly lower retreatment rate (14.8 vs. 35.6%, p<0.001) and complication rate (1.9 vs. 5.5%, p=0.031) compared with the FS group. This superiority remained significant in the stone size <1cm stratified group. In the stone size >1cm group, the stone-free rate (32.4 vs. 17.8%, p=0.028), disintegration rate (89.2 vs. 54.8%, p=0.031) and retreatment rate (21.6 vs. 53.4%, p<0.001) were still significantly better in the USa group, however there was no significant difference in the complication rate. The most common complication was post-SWL-related flank pain.Conclusion: Extracorporeal SWL using ultrasound combined with fluoroscopy for stone localization and real-time tracking, provides higher stone-free rates and stone disintegration rates, as well as lower retreatment rates and fewer complications.

scholarly journals Management of upper ureteral stones exceeding 15 mm in diameter: Shock wave lithotripsy versus semirigid ureteroscopy with holmium:yttrium–aluminum–garnet laser lithotripsy

2016 ◽  
Vol 4 ◽  
pp. 205031211668518 ◽  
Author(s):  
Hamdy Aboutaleb ◽  
Mohamed Omar ◽  
Shady Salem ◽  
Mohamed Elshazly
Keyword(s):  
Shock Wave ◽  
Shock Wave Lithotripsy ◽  
Perioperative Complications ◽  
Operation Time ◽  
Laser Lithotripsy ◽  
Ureteral Stones ◽  
Complication Rates ◽  
Stone Free Rate ◽  
Free Rate

Objectives: We conducted a retrospective study to evaluate the efficacy and outcome of shock wave lithotripsy versus semirigid ureteroscopy in the management of the proximal ureteral stones of diameter exceeding 15 mm. Methods: During the 2009−2014 study period, 147 patients presenting with the proximal ureteral stones exceeding 15 mm in diameter were treated. Both shock wave lithotripsy and ureteroscopy with laser lithotripsy were offered for our patients. A 6/8.9 Fr semirigid ureteroscope was used in conjunction with a holmium:yttrium–aluminum–garnet laser. The stone-free rate was assessed at 2 weeks and 3 months post-treatment. All patients were evaluated for stone-free status, operation time, hospital stay, perioperative complications, and auxiliary procedures. Results: Of the 147 patients who took part in this study, 66 (45%) had undergone shock wave lithotripsy and 81 (55%) underwent ureteroscopy. At the 3-month follow-up, the overall stone-free rate in the shock wave lithotripsy group was 39/66 (59%) compared to 70/81 (86.4%) in the ureteroscopic laser lithotripsy group. Ureteroscopic laser lithotripsy achieved a highly significant stone-free rate ( p = 0.0002), and the mean operative time, auxiliary procedures, and postoperative complication rates were comparable between the two groups. Conclusion: In terms of the management of proximal ureteral stones exceeding 15 mm in diameter, ureteroscopy achieved a greater stone-free rate and is considered the first-line of management. Shock wave lithotripsy achieved lower stone-free rate, and it could be used in selected cases.

scholarly journals Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 231
Author(s):  
Ponco Birowo ◽  
William Tendi ◽  
Indah S. Widyahening ◽  
Nur Rasyid ◽  
Widi Atmoko
Keyword(s):  
Hospital Stay ◽  
Prone Position ◽  
Percutaneous Nephrolithotomy ◽  
Complication Rate ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Major Complication ◽  
Stone Free Rate ◽  
Major Complication Rate ◽  
Free Rate

Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 – 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 – 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon’s experience and clinical aspects of the patients.

scholarly journals The Safety and Efficacy of Mini Percutaneous Nephrolithotomy During Learning Curve

2019 ◽  
Vol 18 (2) ◽  
pp. 42-47
Author(s):  
Bikash Bikram Thapa ◽  
Bina Basnet ◽  
Bikash Bahadur Rayamajhi ◽  
Narayan Thapa ◽  
Bharat Bhadur Bhandari
Keyword(s):  
Learning Curve ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Operative Time ◽  
Medium Size ◽  
Stone Size ◽  
Access Sheath ◽  
Stone Free Rate ◽  
The Mean ◽  
Free Rate

Introduction: Since its introduction in 1976, percutaneous renal stone surgery has undergone several modifications. Reduction in size of access sheath was one of them which was first reported by Jackman in 1998. The miniaturisation of access sheath in Mini-Percutaneous Nephrolithotomy surgery has significantly reduced the intervention related morbidity with similar outcome as of standard Percutaneous Nephrolithotomy. Methods: This is a prospective cohort study where a single surgeon without previous experience of independent PCNL surgery performed Mini PCNL under controlled condition for renal stone sized 10 to 30 mm. The outcome was measured in terms of stone free rate and postoperative complications. The association of stone free rate and drop in haemoglobin level with different preoperative and operative variables were calculated with Pearson’s correlation test and p value <0.05 was considered significant. Results: Mini PCNL was performed in total of 63 renal units. The mean age was 37.8 ± 9.9 years with male: female ratio of 1.8:1. The average stone size was 16.8 ± 2.9 mm. The mean operative time was 55.2 ± 19.0 (30-110) minutes. The stone free rate was 98.2 ± 3.6 %. The mean drop in haemoglobin was 1.3 ± 0.8 and blood transfusion rate was 4.7%. The average hospital stay was 2.6 ± 1.3 days. The grade I complications was 15.8% and grade II and III was 7.9% each. Stone free rate was significantly associated with stone number (r = -0.47, p = 0.004). Similarly fall in haemoglobin was associated with total operative time (r = 0.49, p = 0.003). The stone size, hardness of stone (HU) and size of access sheath had no significant association with stone free rate and fall in haemoglobin. Conclusions: Mini PCNL is as effective as standard PCNL with higher safety margin in small and medium size stone (10 to 30 mm) during learning curve of endo-urology procedure.  

Successful Transition to Robotic-Assisted Lobectomy With Previous Proficiency in Thoracoscopic Lobectomy

2019 ◽  
Vol 14 (3) ◽  
pp. 263-271 ◽  
Author(s):  
Robert E. Merritt ◽  
Peter J. Kneuertz ◽  
Desmond M. D’Souza
Keyword(s):  
Length Of Stay ◽  
Lymph Nodes ◽  
Learning Curve ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Robotic Assisted ◽  
Thoracoscopic Lobectomy ◽  
Surgeon Experience ◽  
The Mean

Objective The learning curve and the advantages of transitioning to robotic-assisted lobectomy by a surgeon who is proficient in thoracoscopic lobectomy is currently unknown. The cost of robotic lobectomy has been reported to be higher than thoracoscopic lobectomy and there is no significant decrease in hospital length of stay. Methods This is a retrospective review of 228 patients diagnosed with lung carcinoma who underwent minimally invasive lobectomy from March 2014 to May 2018. A total of 114 patients underwent thoracoscopic lobectomy and 114 patients underwent robotic-assisted lobectomy. The data collected included patient demographics, tumor characteristics, morbidity, mortality, operative times, and hospital length of stay. Results A total of 114 patients underwent thoracoscopic lobectomy and 114 patients underwent robotic-assisted lobectomy. The patients in each group were similar in age, gender, smoking status, FEV-1, tumor histology, and pathologic stage. The mortality and complication rates were similar. The mean number of total lymph nodes and N2 lymph nodes were significantly higher in the robotic lobectomy group ( P < 0.0001). The mean operative time was shorter in the robotic group. The median hospital length of stay (4 days) was similar between the 2 groups ( P = 0.99). Conclusion The results of this report suggest that thoracoscopic and robotic-assisted lobectomy have similar outcomes when a surgeon proficient in the thoracoscopic technique completely transitions to the robotic-assisted technique. The learning curve was relatively accelerated in this single-surgeon experience. There may be an advantage for robotic-assisted lobectomy in the total number of lymph nodes harvested.

scholarly journals Comparison of Ultrasound-assisted and Pure Fluoroscopy-guided Extracorporeal Shockwave Lithotripsy for Renal Stones

2020 ◽  
Author(s):  
Tsung-Hsin Chang ◽  
Wun-Rong Lin ◽  
Wei-Kung Tsai ◽  
Pai-Kai Chiang ◽  
Marcelo Chen ◽  
...  
Keyword(s):  
Complication Rate ◽  
Renal Stones ◽  
Complication Rates ◽  
Disintegration Rate ◽  
Stone Size ◽  
Stone Free Rate ◽  
The Usa ◽  
Retreatment Rate ◽  
Ultrasound Assisted ◽  
Free Rate

Abstract Background In this study, we aimed to compare the efficacy and clinical outcomes of shock wave lithotripsy (SWL) for patients with renal stones using pure fluoroscopy (FS) or ultrasound-assisted (USa) localization with two lithotripters. Methods We retrospectively identified 425 patients with renal calculi who underwent SWL with either a LiteMed LM-9200 ELMA lithotripter (209 cases), which combined ultrasound and fluoroscopic stone targeting or a Medispec EM-1000 lithotripter machine (216 cases), which used fluoroscopy for stone localization and tracking. The patient demographic data, stone-free rates, stone disintegration rates, retreatment rates and complication rates were analyzed. Results The USa group had a significantly higher overall stone-free rate (43.6 vs. 28.2%, p < 0.001) and stone disintegration rate (85.6 vs. 64.3%, p < 0.001), as well as a significantly lower retreatment rate (14.8 vs. 35.6%, p < 0.001) and complication rate (1.9 vs. 5.5%, p = 0.031) compared with the FS group. This superiority remained significant in the stone size < 1 cm stratified group. In the stone size > 1 cm group, the stone-free rate (32.4 vs. 17.8%, p = 0.028), disintegration rate (89.2 vs. 54.8%, p = 0.031) and retreatment rate (21.6 vs. 53.4%, p < 0.001) were still significantly better in the USa group, however there was no significant difference in the complication rate. The most common complication was post-SWL-related flank pain. Conclusion Extracorporeal SWL using ultrasound combined with fluoroscopy for stone localization and real-time tracking, provides higher stone-free rates and stone disintegration rates, as well as lower retreatment rates and fewer complications.

scholarly journals Learning curve of trainees performing laparoscopic appendectomy- a register-based study

2021 ◽  
Author(s):  
Nathalie Young ◽  
Lennart Boström ◽  
Gabriel Sandblom ◽  
Hans Järnbert Pettersson
Keyword(s):  
Learning Curve ◽  
Complication Rate ◽  
Moving Average ◽  
Operation Time ◽  
Patient Characteristics ◽  
First Year ◽  
Complication Rates ◽  
Surgical Trainees ◽  
Trainee Surgeon ◽  
Training Programmes

Abstract Background Appendectomy is one of the first procedures that surgical trainees are expected to manage alone. The purpose of this study was to analyse the learning curve of a cohort of surgical trainees and to explore the association between trainee surgeon volume and complication rate. Method The study was based on a cohort extracted from the local appendectomy register at Södersjukhuset (transl. South Hospital), Stockholm. The register includes patient characteristics, surgical method, operation time, and 30-day complications. First-year surgical trainees attending the hospital’s trainee programme were included and followed over five years of training. Trainees who had performed less than ten procedures during the period of the study were excluded. The learning curve was described using moving average of order ten for each trainee, studying the trend in operation time with increasing volume. The cumulative sum technique was used to chart changes in complication rates of the trainees. Results 586 procedures performed by 9 surgical trainees were included, of which 97.6% were performed laparoscopically. A plateau in operation time on the learning curve was reached at 60 procedures. For three of the trainees, the 30-day complication rate decreased after completing the learning curve, whereas for two others it increased. In a multivariate analysis, operation times differed more between the trainees than it did between procedures performed early or late in the programme. Shortest versus longest mean operation time (41 min versus 89 min). Conclusion At least 60 procedures are required to reach sufficient proficiency in appendectomy. This highlights the importance of meticulous selection of surgical trainees, structure of training programmes, feedback, and assessment.

scholarly journals Safety and efficacy of percutaneous nephrolithotomy for the treatment of paediatric urolithiasis

2012 ◽  
Vol 94 (8) ◽  
pp. 588-592 ◽  
Author(s):  
R Veeratterapillay ◽  
MBK Shaw ◽  
R Williams ◽  
P Haslam ◽  
A Lall ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Calculi ◽  
Clearance Rates ◽  
Stone Clearance ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Surgeon Experience ◽  
The Mean ◽  
Free Rate

INTRODUCTION Paediatric percutaneous nephrolithotomy (PCNL) has revolutionised the treatment of paediatric nephrolithiasis. Paediatric PCNL has been performed using both adult and paediatric instruments. Stone clearance rates and complications vary according to the technique used and surgeon experience. We present our experience with PCNL using adult instruments and a 28Fr access tract for large renal calculi in children under 18 years. METHODS All patients undergoing PCNL at our institution between 2000 and 2009 were reviewed. Demographics, surgical details and post-operative follow-up information were obtained to identify stone clearance rates and complications. RESULTS PCNL was performed in 32 renal units in 31 patients (mean age: 10.8 years). The mean stone diameter was 19mm (range: 5–40mm). Twenty-six cases required single puncture and six required multiple tracts. Overall, 11 staghorn stones, 10 multiple calyceal stones and 11 single stones were treated. Twenty-seven patients (84%) were completely stone free following initial PCNL. Two cases had extracorporeal shock wave lithotripsy for residual fragments, giving an overall stone free rate of 91% following treatment. There was no significant bleeding or sepsis encountered either during the operation or in the post-operative setting. No patient required or received a blood transfusion. CONCLUSIONS Paediatric PCNL can be performed safely with minimal morbidity using adult instruments for large stone burden, enabling rapid and complete stone clearance.

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