Learning Curve for Retroperitoneoscopic Renal Pedicle Lymphatic Disconnection for Intractable Chyluria: A Single Surgeon's Experience

To evaluate the surgical experience and outcomes of retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD) and to define a learning curve for this minimally invasive technique to treat patients with intractable chyluria. We collected the clinical records of 40 consecutive patients who were selected for RRPLD of 42 renoureteral units between 2007 and 2010 for chyluria by a single surgeon with no experience for this procedure. Patients’ demographics and peri-operative parameters were recorded and compared. Operation time, blood loss, and other peri-operative parameters were analyzed to document the learning curve for the procedure. All the 40 patients, 14 women and 26 men, underwent RRPLD successfully, and no open conversions were needed. The median operation time was 77.5 minutes [interquartile ranges (IQR): 69.0 to 89.0] and the median blood loss was 46.5 mL (IQR: 35.0 to 67.0). A total of five complications occurred (11.9%). We divided the patient cohort to the first 20 (group 1) and the last 20 (group 2) patients since operation time reached a plateau after about 20 cases. There were significant differences in the operation time (P =. 000) and the blood loss (P =. 006) between the two groups. The two phases did not differ in terms of demographic data, peri-operative complications, gastrointestinal recovery time, extubation time, or hospitalization duration. Retroperitoneoscopic renal pedicle lymphatic disconnection is a well standardized and reproducible procedure. This study of the learning curve of a single surgeon suggests that competence at performing RRPLD is reached after approximately 20 cases.