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MP33-17 THE LEARNING CURVE FOR RETROGRADE INTRA-RENAL SURGERY(RIRS): HOW MANY CASES ARE NECESSARY?

2016; Lippincott Williams & Wilkins; Volume: 195; Issue: 4S Linguagem: Inglês

10.1016/j.juro.2016.02.1374

1527-3792

José Arnaldo Shiomi da Cruz, Cesar Thiago, Ugo de Queiros Barros, Ricardo Leo Felts de la Roca, João Paulo Cunha Lima, Ricardo Di Migueli,

Kidney Stones and Urolithiasis Treatments

You have accessJournal of UrologyStone Disease: Surgical Therapy III1 Apr 2016MP33-17 THE LEARNING CURVE FOR RETROGRADE INTRA-RENAL SURGERY(RIRS): HOW MANY CASES ARE NECESSARY? Jose Arnaldo Shiomi da Cruz, Cesar Thiago, Ugo de Queiros Barros, Ricardo Leo Felts de la Roca, Joao Paulo Cunha Lima, and Ricardo Di Migueli Jose Arnaldo Shiomi da CruzJose Arnaldo Shiomi da Cruz , Cesar ThiagoCesar Thiago , Ugo de Queiros BarrosUgo de Queiros Barros , Ricardo Leo Felts de la RocaRicardo Leo Felts de la Roca , Joao Paulo Cunha LimaJoao Paulo Cunha Lima , and Ricardo Di MigueliRicardo Di Migueli View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1374AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Retrograde intra-renal surgery (RIRS) has been recognized as a very valuable tool for the treatment of urinary stones. In order to one achieve optimal results, adequate training is mandatory. Nevertheless, the learning curve for RIRS has not been well stablished yet. The purpose of this study is to estimate the minimum number of procedures required for a surgeon to perform RIRS consistently. METHODS A urology resident of the PGY-3 with experience of more than 250 cases of endoscopic semi-rigid ureterorenolithotripsy, therefore, within the plateau of the learning curve, had his first 80 RIRS recorded and analyzed by 2 experienced surgeons in endourology. A qualitative analysis was performed with a surgical assessment tool previously published in the literature encompassing 5 parameters: tissue management, bimanual dexterity, depth perception, autonomy and efficiency; and a quantitative analysis was performed based on the time needed for: sheath placement, stone treatment, JJ stent placement, total sheath time and total operative time. Procedures were divided into 4 groups: from first to twentieth (Group I), from twenty-first through fortieth (Group II), from the forty-first to the sixtieth (Group III) and from the sixty-first to the eightieth. RESULTS The mean age of patients was 41 ± 12.5 years, with 39 (48.7%) male patients and 41 (51.3%) were female. There was no difference in size of the stones between the groups: 11.4 ± 7.3 vs. 8.0 ± 3.8 vs 11.1 ± 5.2 vs 13.7 ± 7.7 (p = 0.12, groups I, II, III and IV respectively). All qualitative variables had significant variation between groups (p <0.001) except between groups III and IV. In the quantitative analysis there was difference between groups I and IV in time JJ stent placement (p = 0.012). There was an increasing difference in time to: sheath placement (p <0.001) and total operative time (p = 0.004). Time for stone treatment (p =0.011) was only significant between groups I,II and III. There was difference in total sheath time only between groups I and III (p = 0.023). There were no intraoperative complications. CONCLUSIONS After 60 cases all variables did not show improvement in our series. Therefore, it seems that 60 cases is a reasonable estimative for experience needed to achieve the plateau of the learning curve for RIRS. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e443 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jose Arnaldo Shiomi da Cruz More articles by this author Cesar Thiago More articles by this author Ugo de Queiros Barros More articles by this author Ricardo Leo Felts de la Roca More articles by this author Joao Paulo Cunha Lima More articles by this author Ricardo Di Migueli More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...