title: Should oncological cases of upper urinary system be excluded at the beginning of the laparoscopic learning curve?
abstract: OBJECTIVE
  The place of oncological cases of upper urinary system in the laparoscopic learning curve was investigated.
  
  
  METHODS
  A total of 139 patients from two different centers underwent laparoscopic operations and were included in this retrospective study.
  
  
  RESULTS
  Mean operative times for oncological, and non-oncological cases were 101.3 (range 60-450), and 102.7 (45-490) minutes respectively. Fourty-two (31.3 %) patients were oncological cases. In 4 oncological cases, the surgeons switched to open surgery because of massive bleeding and six (14.2 %) oncological cases required blood transfusions during peri/postoperative periods. Pulmonary embolism was observed in one oncological case. In one non-oncological case, the surgeon switched to open surgery because of intestinal perforation and 10 (9.7 %) non-oncological cases needed blood transfusions during peri/postoperative periods. In addition, some complications such as intestinal perforation (n=1), mechanical ileus (n=1), and pulmonary embolism (n=1) were observed during postoperative period. Intestinal perforation was repaired using laparoscopic (n=1) method. Mechanical ileus was approached with open surgical technique. Mean hospital stay of the patients in the oncological and non-oncological series were 4.5 (3-23) and 4.5 (3-30) days respectively.
  
  
  CONCLUSIONS
  We think that renal oncological cases should be included in the spectrum of laparoscopic indications even at the beginning of the learning curve. Certainly, we still share the opinion that cancer cases which require highly challenging surgeries like radical cystectomy, and prostatectomy should be postponed till to gaining of higher level of experience.
authors.affiliation: Fatih Sultan Mehmet Research & Training Hospital, Dept. of Urology, Istanbul, Turkey.
authors.forename: Özgür Haki
authors.initials: ÖH
authors.lastname: Yüksel
authors.affiliation: Okmeydani Research & Training Hospital, Dept. of Urology, Istanbul, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Ötünçtemur
authors.affiliation: Okmeydani Research & Training Hospital, Dept. of Urology, Istanbul, Turkey.
authors.forename: Emin
authors.initials: E
authors.lastname: Özbek
authors.affiliation: Fatih Sultan Mehmet Research & Training Hospital, Dept. of Urology, Istanbul, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Uruç
authors.affiliation: Fatih Sultan Mehmet Research & Training Hospital, Dept. of Urology, Istanbul, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Verit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D000075202:Contraindications; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D015653:Cystectomy; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology; D007416:Intestinal Perforation / Q000209:etiology*; D007431:Intraoperative Complications / Q000453:epidemiology*; D010535:Laparoscopy / Q000009:adverse effects*; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D061646:Operative Time; D011468:Prostatectomy; D011655:Pulmonary Embolism / Q000209:etiology*; D012189:Retrospective Studies; D014571:Urologic Neoplasms / Q000601:surgery*; D055815:Young Adult