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Keywords:

  • education;
  • learning curves;
  • training;
  • urology

Objective

  • To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures.

Patient and Methods

  • The MEDLINE, EMBASE and PsycINFO databases were systematically searched for studies published up to December 2011.
  • Studies pertaining to learning curves of urological procedures were included.
  • Two reviewers independently identified potentially relevant articles.
  • Procedure name, statistical analysis, procedure setting, number of participants, outcomes and learning curves were analysed.

Results

  • Forty-four studies described the learning curve for different urological procedures.
  • The learning curve for open radical prostatectomy ranged from 250 to 1000 cases and for laparoscopic radical prostatectomy from 200 to 750 cases.
  • The learning curve for robot-assisted laparoscopic prostatectomy (RALP) has been reported to be 40 procedures as a minimum number.
  • Robot-assisted radical cystectomy has a documented learning curve of 16–30 cases, depending on which outcome variable is measured.
  • Irrespective of previous laparoscopic experience, there is a significant reduction in operating time (P = 0.008), estimated blood loss (P = 0.008) and complication rates (P = 0.042) after 100 RALPs.

Conclusions

  • The available literature can act as a guide to the learning curves of trainee urologists. Although the learning curve may vary among individual surgeons, a consensus should exist for the minimum number of cases to achieve proficiency.
  • The complexities associated with defining procedural competence are vast.
  • The majority of learning curve trials have focused on the latest surgical techniques and there is a paucity of data pertaining to basic urological procedures.