Learning curve analysis for laparoendoscopic single-site radical nephrectomy

Background and Purpose: Little data are available on the learning curve for laparoendoscopic single-site (LESS) surgery. We aimed to evaluate the learning curve for LESS radical nephrectomy for localized renal-cell carcinoma (RCC). Patients and Methods: Data from the first 50 consecutive patients who underwent LESS radical nephrectomy were reviewed for evaluation of the learning curve. The surgical procedure was broken down into its three essential components (medial retraction of colon, hilar dissection, and kidney mobilization) through a video review, and each operative time was separately recorded for learning curve analysis. Patient demographic data, variable surgical outcomes, and pathologic outcomes were analyzed. Overall learning curve for LESS radical nephrectomy was evaluated, as well as individual learning curves for three essential steps of LESS radical nephrectomy. Results: Operative time gradually decreased in about the first 15 cases and remained stable in the next 35 cases. The rate of perioperative complications did not differ significantly between groups, although it was higher in cases 1 to 15 and 16 to 30 than in cases 30 to 50 (20% vs 20% vs 0%). Surgeon experience regarding LESS was significantly correlated with time for medial retraction of colon (r=-0.502, P<0.001) and time for kidney mobilization (r=-0.457, P=0.001), but not with time for hilar dissection (r=-0.351, P=0.097). Conclusions: LESS radical nephrectomy for localized RCC is a safe and effective procedure needing a short learning curve for achievement of satisfying surgical outcomes in the hands of an experienced laparoscopic surgeon. Kidney mobilization appeared to be the step most affected by the learning curve in the early stage of LESS radical nephrectomy.