The learning curve of bilateral laparoscopic varicocelectomy: a prospective study

BELKOVSKY, MIKHAEL; PASSEROTTI, CARLO CAMARGO; MAXIMIANO, LINDA FERREIRA; OTOCH, JOSÉ PINHATA; CRUZ, JOSE ARNALDO SHIOMI DA

doi:10.1590/0100-6991e-20233456-en

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Revista do Colégio Brasileiro de Cirurgiões

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Original article • Rev. Col. Bras. Cir. 50 • 2023 • https://doi.org/10.1590/0100-6991e-20233456-en copy

The learning curve of bilateral laparoscopic varicocelectomy: a prospective study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Varicocele occurs in 15% of general male population and in 35% of infertile men. Since 1992, surgical correction with laparoscopic varicocelectomy is the gold standard for treatment of symptomatic patients or patients with abnormal seminal analysis. The learning curve for this frequently performed procedure has not yet been described. In the present study, we investigated the learning curve of a single urologist in training performing his first 21 laparoscopic varicocelectomies using qualitative and quantitative tools to evaluate his performance during the process. Our results show that 14 bilateral laparoscopic varicocelectomies are enough to achieve the plateau of the learning curve.

Keywords:
Learning Curve; Urologic Surgical Procedures, Male; Varicocele

Depth perception^a,b
1 - Constantly overshoots target, wide swings, slow to correct
2.
3 - Some overshooting or missing target, but quick to correct
4.
5 - Accurately directs instruments in the correct plane to target
Bimanual dexterity^a,b
1 - Uses only one hand, ignores non dominant hand, poor coordination between hands
2.
3 - Users both hands, but does not optimize interaction between hands
4.
5 - Expertly uses both hands in a complementary manner to provide optimal exposure
Efficiency^a,b
1 - Uncertain, inefficient efforts; many tentative movements; constantly changing focus or persisting without progress
2.
3 - Slow, but planned movements are reasonably organized
4.
5 - Confident, efficient and safe conduct, maintains focus on task until it is better performed by way of an alternative approach
Tissue handling^a,b
1 - Rough movements, tears tissue, injures adjacent structures, poor grasper control, grasper frequently slips
2.
3 - Handles tissue reasonably well, minor trauma to adjacent tissue (i.e., occasional unnecessary bleeding or slipping of the grasper)
4.
5 - Handles tissues well, applies appropriate traction, negligible injury to adjacent structures
Autonomy^a,b
1. Unable to complete entire task, even with verbal guidance
2.
3. Able to complete task safely with moderate guidance
4.
5. Able to complete tasks independently without guidance.

	Bimanual dexterity	Depth perception	Efficiency	Autonomy	Tissue handling
Group I (mean ± SD)	3±0	3±0.0	3.4±0.5	3±0	3.4±0.5
Group II (mean ± SD)	4±0.8	4.1±1.0	4.1±1.0	4.1±1.0	4.2±0.9
Group III (mean ± SD)	4.2±0.95	4.7±0.7	4.8±0.3	4.7±0.7	4.7±0.4
Group I vs II - p	0.007	0.015	0.14	0.015	0.06
Group II vs III - p	0.558	0.271	0.121	0.271	0.31

	Operative time (min)	Postoperative pain (Day 1)	Postoperative pain (Day 7)	Postoperative pain (1 month)	Postoperative pain (6 months)	Complications
Group I (mean ± SD)	38.5±4.7	4.8±2.0	3.5±1.5	0	0	0
Group II (mean ± SD)	31.7±7.2	3.4±1.3	1.8±1.4	0	0	0
Group III (mean ± SD)	31.7±2.8	3.8±0.9	1.8±1.4	0	0	0
Group I vs II - p	0.058	0.15	0.052	>0.999	>0.999	>0.999
Group II vs III - p	0.116	0.508	>0.999	>0.999	>0.999	>0.999

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[1] Mailing address: Jose Arnaldo Shiomi da Cruz E-mail: arnaldoshiomi@yahoo.com.br