Complications of laparoscopic procedures after concentrated training in urological laparoscopy

Purpose: To increase the safety and efficiency of laparoscopic surgery clin ical training programs have been developed to increase the skill and effici ency of urological trainees. We evaluated the impact of dedicated laparosco py training on the rate and type of complications after trainees entered cl inical practice. Materials and Methods: Data were obtained from 13 centers where laparoscopy was performed by a single surgeon with at least 12 months of training in u rological laparoscopy before clinical practice. Data included training expe rience, laparoscopic procedures performed after commencing clinical practic e and associated complications. Procedures were classified as easy, moderat e and difficult. Results: During training each surgeon participated in a mean of 71 cases. I n clinical practice a total of 738 laparoscopic cases were performed with t he group reporting an overall complication rate of 11.9%. The rate was unch anged when the initial 20, 30 and 40 cases per surgeon were compared with a ll subsequent cases (12%, 11.9% and 12% versus 11.8 to 12%, respectively). The re-intervention rate was 1.1%. The complication rate increased with cas e difficulty. Overall and early complication rates attributable to laparosc opic technique in the initial 20, 30 and 40 cases were identical. The most common complications were neuropathy in 13 patients, urine leakage/urinoma in 9, transfusion in 7 and ileus in 5. Conclusions: The complication rate of surgeons who completed at least 12 mo nths of laparoscopy training did not differ according to initial versus sub sequent surgical experience. Intensive training seems to decrease the impac t of the learning curve for laparoscopy.