title: Complications of laparoscopic procedures after concentrated training in urological laparoscopy.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas 75390-9110, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Cadeddu
authors.forename: J S
authors.initials: JS
authors.lastname: Wolfe
authors.forename: S
authors.initials: S
authors.lastname: Nakada
authors.forename: R
authors.initials: R
authors.lastname: Chen
authors.forename: A
authors.initials: A
authors.lastname: Shalhav
authors.forename: J T
authors.initials: JT
authors.lastname: Bishoff
authors.forename: B
authors.initials: B
authors.lastname: Hamilton
authors.forename: P G
authors.initials: PG
authors.lastname: Schulam
authors.forename: M
authors.initials: M
authors.lastname: Dunn
authors.forename: D
authors.initials: D
authors.lastname: Hoenig
authors.forename: M
authors.initials: M
authors.lastname: Fabrizio
authors.forename: S
authors.initials: S
authors.lastname: Hedican
authors.forename: T D
authors.initials: TD
authors.lastname: Averch
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology; D014572:Urology / Q000193:education*