Cumulative sum analysis of the learning curve for retrograde intrarenal stone surgery in newbie surgeons.
Ho Young Koo, Jung Wan Yoo, Yeon Joo Kim, Hyun Kyung Jang, Byeong Jo Jeon, Hoon Choi, Jae Hyun Bae, Jae Young Park, Bum Sik Tae
Author Information
Ho Young Koo: Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 425-707, Korea.
Jung Wan Yoo: Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 425-707, Korea.
Yeon Joo Kim: Department of Urology, Daegu Fatima Hospital, Daegu, Korea.
Hyun Kyung Jang: Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 425-707, Korea.
Byeong Jo Jeon: Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 425-707, Korea.
Hoon Choi: Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 425-707, Korea.
Jae Hyun Bae: Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 425-707, Korea.
Jae Young Park: Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 425-707, Korea.
Bum Sik Tae: Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-Ro, Danwon-Gu, Ansan, 425-707, Korea. blue2you@korea.ac.kr. ORCID
INTRODUCTION: This study investigated the learning curve of retrograde intrarenal surgery (RIRS) in patients with medium-sized stones using cumulative sum analysis (CUSUM) to evaluate the competence and proficiency of three new surgeons during their first RIRS procedures. MATERIALS AND METHODS: We conducted a retrospective review of 227 patients from 2019 to 2022 at a single institution. The patients were divided into four groups based on the operating surgeon: tutor surgeon (85 patients), newbie surgeon A (21 patients), newbie surgeon B (85 patients), and newbie surgeon C (36 patients). Patients had one or multiple stones with the largest stone diameter fell within the range of 10-30 mm. Fragmentation efficacy was calculated as "removed stone volume (mm3) divided by operative time (minutes)." CUSUM analysis monitored changes in fragmentation efficacy and validated surgical outcomes. RESULTS: No statistically significant differences were observed in the total stone volume, maximum stone size, or total operation time between the three newbie surgeons and the tutor surgeon. The mean fragmentation efficacy value was comparable among the newbie surgeons, but significantly different from that of the tutor surgeon. The minimum acceptable fragmentation efficacy level was set at 25.12 mL/min, based on the tutor's average value. The CUSUM curves for the three surgeons initially remained relatively flat until Cases 12-15, after which they increased and eventually plateaued. Stone-free rates and postoperative complications did not differ significantly among the surgeons. CONCLUSION: Learning curve analysis for the three newbie surgeons indicated that approximately 12-15 cases were required to reach a plateau.
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Grants
2021R1I1A1A01051050/National Research Foundation of Korea
