| Affiliation: | aFrom the Department of Urology, University of Texas Southwestern Medical Center, Dallas and Department of Surgery, University of Texas Health Science Center, San Antonio and Wilford Hall Medical Center, Lackland Air Force Base, Texas, and Departments of Urology, University of Michigan, Ann Arbor, Michigan, University of Wisconsin at Madison, Madison, Wisconsin, Carson City, Nevada, University of Indiana, Methodist Hospital, Indianapolis, Indiana, University of Utah, Salt Lake City, Utah, University of California at Los Angeles and University of Southern California, Los Angeles, California, Albert Einstein College of Medicine, The Bronx, New York, Eastern Virginia Medical Center, Norfolk, Virginia, University of Iowa, Iowa City, Iowa, and University of Pittsburgh, Pittsburgh, Pennsylvania |
| Abstract: | PURPOSE: To increase the safety and efficiency of laparoscopic surgery clinical training programs have been developed to increase the skill and efficiency of urological trainees. We evaluated the impact of dedicated laparoscopy training on the rate and type of complications after trainees entered clinical practice. MATERIALS AND METHODS: Data were obtained from 13 centers where laparoscopy was performed by a single surgeon with at least 12 months of training in urological laparoscopy before clinical practice. Data included training experience, laparoscopic procedures performed after commencing clinical practice and associated complications. Procedures were classified as easy, moderate and difficult. RESULTS: During training each surgeon participated in a mean of 71 cases. In clinical practice a total of 738 laparoscopic cases were performed with the group reporting an overall complication rate of 11.9%. The rate was unchanged when the initial 20, 30 and 40 cases per surgeon were compared with all subsequent cases (12%, 11.9% and 12% versus 11.8 to 12%, respectively). The re-intervention rate was 1.1%. The complication rate increased with case difficulty. Overall and early complication rates attributable to laparoscopic technique in the initial 20, 30 and 40 cases were identical. The most common complications were neuropathy in 13 patients, urine leakage/urinoma in 9, transfusion in 7 and ileus in 5. CONCLUSIONS: The complication rate of surgeons who completed at least 12 months of laparoscopy training did not differ according to initial versus subsequent surgical experience. Intensive training seems to decrease the impact of the learning curve for laparoscopy. |
