Experience and learning curve of retroperitoneal laparoscopic ureterolithotomy

Learning Curve in the Extraction of Impacted Lower Third Molars: A Prospective Cohort Study

INTRODUCTION

Third molar removal is one of the most common surgical procedures in dentistry. Therefore, it is important to evaluate the learning curve of dentists undergoing surgical training. Thus, the aims of this study were to assess the performance of oral surgery residents in third molar extractions based on operative time and the occurrence of incidents/complications, and to determine which variables are associated with surgical difficulty.

MATERIAL AND METHODS

A prospective cohort study was carried out in adults requiring an impacted lower third molar extraction. All procedures were performed by residents of a master's degree in Oral Surgery and Implantology. The outcome variables were operative time and surgeon-reported difficulty. A descriptive, bivariate and multivariate analysis was performed.

RESULTS

One hundred and 74 patients were operated on by six students. Similar performance was observed among the surgeons. Although a significant improvement in operative time was seen after 10 cases, a non-significant decreasing trend of incidents was also found. The multivariate analysis revealed an association between difficulty with crown/root sectioning and impaction against the second molar.

CONCLUSIONS

At least 10 lower impacted third molar extractions performed by postgraduate students with experience in tooth extractions are required to improve the operative time. Incidents seem to decrease slightly with the number of procedures performed. Surgical difficulty seems to be related to the need for crown/tooth sectioning and greater impaction against the second molar. Further studies are required to confirm these findings.

Laparoscopic ureterolithotomy; which is better: Transperitoneal or retroperitoneal approach?

OBJECTIVE

This was a prospective study to compare the outcome of laparoscopic transperitoneal ureterolithotomy (LTU) with laparoscopic retroperitoneal ureterolithotomy (LRU) as a primary treatment for a large stone in the proximal ureter.

MATERIAL AND METHODS

A total of 24 patients with a solitary, large (>1.5 cm), and impacted stone in the proximal ureter was selected and randomly divided into two groups. The first group included 13 patients who were treated by LTU, and the second group included 11 patients who were treated by LRU. Patient demographics and stone characteristics as well as the operative and postoperative data of both groups were compared and statistically analyzed.

RESULTS

There was no significant difference between the two groups regarding patient demographics and stone characteristics. The mean operative time was significantly shorter in the LTU group than in the LRU group [116.2±21.8 min vs 137.3±17.9 min, respectively (p=0.02)]. The mean time to oral intake was significantly longer in the LTU group than in the LRU group [21.2±4.9 h vs 15.5±2.8 h, respectively (p=0.002)]. There was significant higher rate (27.3%) of changing to open surgery in LRU (p=0.04). The stone-free rate was significantly higher in the LTU group than in the LRU group [100% vs. 72.8%, respectively (p=0.03)]. There was no statistically significant difference between the two groups regarding the mean blood loss, mean hospital stay, mean analgesia dose, blood transfusion rate, postoperative fever, and stone migration during surgery.

CONCLUSION

Both approaches of laparoscopic ureterolithotomy are effective in treating large impacted stones in the proximal ureter. LTU has significantly shorter operative time and lower rate of open conversion but has a significantly longer time to oral intake.