To explore the application of standardized three-step approach in improving the learning curve of laparoscopic radical nephrectomy via trans-abdominal approach.

Clinical data of 60 patients undergoing laparoscopic radical nephrectomy via trans-abdominal approach performed by the same surgeon in our hospital from February 2015 to May 2017 were retrospectively analyzed. Clinical data were collected according to the date of admission and divided into the experimental (n=30) and control groups (n=30). In the control group, patients enrolled from February 2015 to July 2016 underwent surgery without the standardized three-step approach. In the experimental group, those enrolled from August 2016 to May 2017 received surgery with the standardized three-step approach.

Age, weight, tumor side and size had no difference between two groups (allP>0.05). The operation time in the experimental group was (100±27) min, shorter than that in the control group (117±33) min (t=6.374,P<0.05). In the experimental group, the intraoperative blood loss was less than the control group [(142±50) ml vs (201±75) ml,P<0.01]. The incidence of postoperative complications was different between the experimental and control groups (3.33% vs 6.66%,P<0.05). The length of hospital stay wasn't different between the two groups (P>0.05). The learning curve was delineated by referring to the operation time. In the experimental group, 15 patients reached the plateau phase and 25 cases in the control group (P<0.05).

The radical nephrectomy through the standardized three-step approach can reduce operation time, decrease intraoperative blood loss, shorten surgical process and improve learning curve of the surgery.