Aim: To evaluate the learning curve of hand-assisted retroperitoneoscopic nephrectomy (HALS) performed by less-experienced surgeons.
Methods: The operative records of 166 patients, including 103 with renal tumors and 63 with renal pelvic or ureteral tumors, who underwent HALS performed by 18 less-experienced urologists were reviewed.
Results: The insufflation time in the first four cases was significantly longer than that in the sixteenth and later cases. The insufflation time in cases 5-10 was 14-24 min longer than that in the cases 16 onward, although the differences were not significant. The estimated blood loss did not differ in each group of cases. The complication rate in early cases, in which the operators' experience was five cases or less, was 6% (4/71), while that in later cases was also 7% (7/95). In the analysis of the learning curve of a single surgeon who performed 57 procedures, the insufflation time in cases 1-5 was significantly longer than in cases 41-57. The insufflation times in cases 5-10 were 45 min longer than those in cases 41-57, although the difference was not significant. The estimated blood loss did not differ in each group of cases. Complications did not seem related to operation experience.
Conclusion: In HALS, 5-10 cases were necessary for less-experienced urologists to gain average operating skills for this procedure. It may be reasonable for less-experienced surgeons to begin standard laparoscopic procedures after experiencing 10 cases of the present procedure.