title: Complications of urologic laparoscopic surgery: a center surgeon's experience involving 601 procedures including the learning curve.
abstract: When indications for laparoscopy were expanded to include a variety of urologic diseases, this increased the importance of prevention of complications, especially during the surgeons' learning curve period. Therefore, we evaluated the complications of urologic laparoscopic surgery in the course of one surgeon's experience including the learning curve after completing his long-term fellowship program. From December 2004 to August 2010, a total of 601 urologic laparoscopic surgical procedures were performed by a single surgeon who had finished a 9-month fellowship program at an experienced center. The intra- and postoperative complications of these cases were documented and graded according to the modified Clavien classification system, and then compared with the first and second 3-year periods. Of these 601 laparoscopic procedures, 47 complications occurred in 38 patients, resulting in a total complication rate of 7.8%. Conversion to open surgery occurred in four (0.6%) patients. Clavien grades I and II accounted for minor complications and occurred in 36 (5.9%) patients, whereas grades III, IV, and V accounted for major complications, which occurred in 11 (1.8%) patients. The annual complication rates formed a plateau in the 3rd year. Complication rates were significantly lower in the second 3-year period compared with the first 3 years (p<0.05). Despite the well-organized training program and transferability, surgeons must practice caution in the early years until they become more experienced. In spite of the presence of experienced laparoscopic surgeons, the surgical team needs time to gain experience. These factors cause complication rates to form a plateau in terms of time and experience.
authors: Department of Urology, School of Medicine, Akdeniz University, Antalya, Turkey. yigitakin@yahoo.com
authors: Yigit
authors: Y
authors: Akin
authors: Mutlu
authors: M
authors: Ates
authors: Orcun
authors: O
authors: Celik
authors: Murat
authors: M
authors: Ucar
authors: Selcuk
authors: S
authors: Yucel
authors: Tibet
authors: T
authors: Erdogru
mesh_terms: D002983:Clinical Competence; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects* / Q000193:education; D059032:Learning Curve; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000193:education
references: Eur Urol. 2006 Jan;49(1):113-9
references: 16337330
references: Endoscopy. 1976 Feb;8(1):33-4
references: 16743
references: J Urol. 1999 Sep;162(3 Pt 1):765-70; discussion 770-1
references: 10458362
references: Urology. 2001 Dec;58(6):899-903
references: 11744454
references: Singapore Med J. 2010 Aug;51(8):650-4
references: 20848063
references: Curr Opin Urol. 2000 Jul;10(4):351-7
references: 10918974
references: Endosc Surg Allied Technol. 1995 Feb;3(1):9-15
references: 7757446
references: J Urol. 1999 Jun;161(6):1776-80
references: 10332433
references: J Endourol. 2010 Feb;24(2):253-60
references: 20064000
references: J Urol. 2005 Aug;174(2):673-8; discussion 678
references: 16006945
references: Urol Int. 2008;80(3):237-44
references: 18480623
references: J Urol. 1998 Jul;160(1):18-21
references: 9628596
references: J Urol. 2000 Feb;163(2):418-22
references: 10647644
references: Urology. 1999 Feb;53(2):280-6
references: 9933040
references: J Urol. 2005 Mar;173(3):765-8
references: 15711265
references: Eur Urol. 2010 Nov;58(5):733-41
references: 20800341
references: Singapore Med J. 2007 Mar;48(3):217-21
references: 17342290
references: Zhonghua Wai Ke Za Zhi. 2011 Jun 1;49(6):542-5
references: 21914307
references: Urology. 2000 May;55(5):630-4
references: 10792066
references: Urology. 1998 Oct;52(4):566-71
references: 9763072
references: J Urol. 1998 Oct;160(4):1265-9
references: 9751332
references: J Urol. 2000 Jun;163(6):1643-9
references: 10799152
references: Surg Clin North Am. 2000 Oct;80(5):1465-85
references: 11059714
references: J Urol. 2003 Dec;170(6 Pt 1):2292-5
references: 14634399
references: Eur Urol. 2010 Sep;58(3):407-17
references: 20825759