Video-assisted minilaparotomy surgery (VAMS) is a hybrid of open and laparoscopic surgical techniques, so has advantages of both approaches. Here, we examined the learning curve for this procedure. We retrospectively evaluated 50 consecutive patients who underwent VAMS donor nephrectomy performed by a single surgeon (YEY) between March 2015 and March 2016. The learning curve was evaluated using the cumulative sum (CUSUM) method. Measures of surgical performance included total operation time, warm ischemic time, and estimated blood loss. The mean patient age, body mass index, and body surface area were 43.5 years, 23.8 kg/m 2, and 1.7 m 2, respectively. The mean operation time and warm ischemic time were 160.0 minutes and 124.4 seconds. The learning curve of total operation time was best modeled as a second-order polynomial with equation CUSUM OT (minutes) =-0.3802 × case number 2 + 20.315 × case number-41.333 (R 2 = 0.7707). The curve included 3 unique phases: phase 1 (the initial 17 cases), which is the initial learning curve; phase 2 (the middle 23 cases), expert competence, and phase 3 (the subsequent cases), mastery. In terms of warm ischemic time and estimated blood loss, the initial learning was achieved after 16 cases and after 9 to 10 cases, one could achieve competency. The VAMS donor nephrectomy learning curve is shorter than for laparoscopic or robotic hand-assisted donor nephrectomy. Surgeons can become familiar with the procedure and perform it without complications after approximately 16 to 17 operations.
Bibliographical noteFunding Information:
aDepartment of Urology, Urological Science Institute, Yonsei University College of Medicine, bDepartment of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi-do, cDepartment of Urology, Hanyang University College of Medicine, dBrain Korea 21 PLUS Project for Medical Science, Department of Urology, Yonsei University, Seoul, Republic of Korea. ∗Correspondence: Woong Kyu Han, Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea (e-mail: firstname.lastname@example.org). Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Medicine (2018) 97:17(e0560) Received: 26 October 2017 / Accepted: 4 April 2018 http://dx.doi.org/10.1097/MD.0000000000010560
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