The learning curve and experiences of modified single-port laparoscopic ligation of patent processus vaginalis by single surgeon in primary hospital

doi:10.3877/cma.j.issn.1674-3253.2024.06.005

Abstract

Abstract:

Objective

To explore the learning curve and share surgical experiences of modified trans-umbilical single-port laparoscopic ligation of patent processus vaginalis by single surgeon in a primary hospital.

Methods

A retrospective analysis was conducted on the clinical data of 25 children，who underwent modified trans-umbilical single-port laparoscopic ligation of patent processus vaginalis by single surgeon in the Urology department of Kashgar People's Hospital，from July 2023 to January 2024.The learning curve was generated using cumulative sum analysis （CUSUM） method based on cumulative number of surgical cases and the unilateral repair time. After the number of surgical cases required to enter the vertex of the learning curve was determined，the differences between the learning and completion stage were compared.

Results

18 male and 7 female pediatric patients were included in the study，with 21 unilateral and 4 bilateral deficiencies. All surgeries were successfully completed without any additional operating channels or conversion to open surgery. Five cases preoperatively diagnosed as unilateral lesion were identified to have a contralateral patent processus vaginalis intraoperatively and received simultaneous repair surgery. The best fitting model for the CUSUM learning curve was a cubic curve with the equation:y= 0.02x³-1.079x²+14.732x+0.529 （x is the number of surgical cases），which had a high fitting coefficient R²=0.938. The fitting curve crossed the vertex when accumulating to the 9th case，which was recognized as the cut point for dividing the curve into learning stage and the completion stage. No significant difference was found between the two groups in terms of intraoperative blood loss，postoperative pain score，appearance score，and postoperative hospital stay，while the unilateral repair time in the completion stage was significantly shorter than that in the learning stage ［（16±5） min vs （28±5） min，P＜0.001］. There were no significant complications in both groups after 1 month of follow-up.

Conclusions

The modified transumbilical single-port laparoscopic ligation of patent processus vaginalis is safe and effective. The technique can be proficiently mastered after accumulating 9 surgical experiences，which is suitable for application and promotion in grassroots hospitals.

Key words: Single port, Patent processus vaginalis, Learning curve, CUSUM

Donggen Jiang, Yao Feng. The learning curve and experiences of modified single-port laparoscopic ligation of patent processus vaginalis by single surgeon in primary hospital[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(06): 560-565.

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Figures/Tables 4

组别	例数	性别（例）		年龄［岁，（ $\bar{x}$ ±s）］	病程［月，（ $\bar{x}$ ±s）］	侧别（例）			单侧手术时间［min，（ $\bar{x}$ ±s）］	术中出血量［ml，M（Q）］	术后疼痛评分（ $\bar{x}$ ±s）	外观评分［分，M（Q）］	术后住院日［d，M（Q）］	并发症（例）
组别	例数	男	女	年龄［岁，（ $\bar{x}$ ±s）］	病程［月，（ $\bar{x}$ ±s）］	左	右	双	单侧手术时间［min，（ $\bar{x}$ ±s）］	术中出血量［ml，M（Q）］	术后疼痛评分（ $\bar{x}$ ±s）	外观评分［分，M（Q）］	术后住院日［d，M（Q）］	输精管损伤	阴囊水肿	精索血肿	复发
学习期	9	6	3	5.8±1.4	2.8±1.7	3	5	1	28±5	0.5（0）	1.7±1.0	5（0）	1（0）	0	1	0	0
学成期	16	12	4	6.2±1.8	2.4±1.1	7	6	3	16±5	0.5（0）	1.5±0.9	5（0）	1（0）	0	0	1	0
统计值		χ²=0.198		t=-0.567	t=0.608	χ²=0.793			t=5.563	Z=-0.421	t=0.429	Z=-0.101	Z=-0.490	χ²=0.185
P值		0.673		0.567	0.549	0.673			＜0.001	0.673	0.672	0.920	0.624	＞0.999

组别	例数	性别（例）		年龄［岁，（ $\bar{x}$ ±s）］	病程［月，（ $\bar{x}$ ±s）］	侧别（例）			单侧手术时间［min，（ $\bar{x}$ ±s）］	术中出血量［ml，M（Q）］	术后疼痛评分（ $\bar{x}$ ±s）	外观评分［分，M（Q）］	术后住院日［d，M（Q）］	并发症（例）
组别	例数	男	女	年龄［岁，（ $\bar{x}$ ±s）］	病程［月，（ $\bar{x}$ ±s）］	左	右	双	单侧手术时间［min，（ $\bar{x}$ ±s）］	术中出血量［ml，M（Q）］	术后疼痛评分（ $\bar{x}$ ±s）	外观评分［分，M（Q）］	术后住院日［d，M（Q）］	输精管损伤	阴囊水肿	精索血肿	复发
学习期	9	6	3	5.8±1.4	2.8±1.7	3	5	1	28±5	0.5（0）	1.7±1.0	5（0）	1（0）	0	1	0	0
学成期	16	12	4	6.2±1.8	2.4±1.1	7	6	3	16±5	0.5（0）	1.5±0.9	5（0）	1（0）	0	0	1	0
统计值		χ²=0.198		t=-0.567	t=0.608	χ²=0.793			t=5.563	Z=-0.421	t=0.429	Z=-0.101	Z=-0.490	χ²=0.185
P值		0.673		0.567	0.549	0.673			＜0.001	0.673	0.672	0.920	0.624	＞0.999

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