Evaluating the Learning Curve for Percutaneous Nephrolithotomy under Total Ultrasound Guidance.
OBJECTIVE
To investigate the learning curve of percutaneous nephrolithotomy under total ultrasound guidance.


METHODS
One hundred and twenty consecutive PCNL operations under total ultrasound guidance performed by a novice surgeon in a tertiary referral center were studied. Operations were analyzed in cohorts of 15 to determine when a plateau was reached for the variables such as operation duration, ultrasound screening time, tract dilation time, stone-free rate and complication rate. Comparison was made with the results of a surgeon who had performed more than 1000 PCNLs. Fluoroscopy was not used at all during procedure.


RESULTS
The mean operation time dropped from 82.5 min for the first 15 patients to a mean of 64.7 min for cases 46 through 60(P = 0.047). The ultrasound screening time was a peak of 6.4 min in the first 15 cases, whereas it dropped to a mean of 3.9 min for cases 46 through 60(P = 0.01). The tract dilation time dropped from 4.9 min for the first 15 patients to a mean of 3.8 min for cases 46 through 60(P = 0.036). The senior surgeon had a mean operating time, screening time and tract dilation time equivalent to those of the novice surgeon after 60 cases. There was no significant difference in stone free rate and complication rate.


CONCLUSIONS
The competence of ultrasound guided PCNL is reached after 60 cases with good stone free rate and without major complications.
Urology Division, Sheng Jing Hospital, China Medical University, Shenyang, Liaoning Province, China.
Yan
Y
Song
Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province, China.
YaNan
Y
Ma
Urology Division, Sheng Jing Hospital, China Medical University, Shenyang, Liaoning Province, China.
YongSheng
Y
Song
Urology Division, Sheng Jing Hospital, China Medical University, Shenyang, Liaoning Province, China.
Xiang
X
Fei
D000328:Adult; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome