科研之友
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摘要
Purpose: To analyze the effects of a learning curve in laparoscopic approaches in urological surgery and the prevalence of complications in a large medical center. Materials and methods: Clinical data of all patients who underwent laparoscopic surgery at the Department of Urology, West China Hospital, from March 2003 to December 2012 were retrospectively reviewed. All postoperative complications were recorded and classified according to the Clavien-Dindo system, and the parameters of average operating time (OT), estimated blood loss (EBL), length of hospital stay after operation (LOSO), and rate of complication (RC) were analyzed statistically. Results: Of a total of 4707 patients selected, 4293 (91.2%) were treated by a retroperitoneal approach and 414 were treated by a transperitoneal approach. With the gradual maturity of technologies, OT, EBL, LOSO, and RC significantly decreased (P < 0.001). RC reached a plateau after the 3rd year. Furthermore, all postoperative complications according to the Clavien-Dindo system revealed that complications occurred in 778 (16.5%) cases, 78 during surgery and 700 after surgery. Conclusions: Trends in OT, EBL, LOSO, and intra- and postoperative RCs significantly decreased throughout the study period. The 3rd year was regarded as a turning point in the learning curve for laparoscopic surgery. However, the applied range expanded along with an increase in difficult and complicated pRCedures. Complications may be efficiently reduced by summarizing RC and analysis of treatments and characteristics of the learning curve.
