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Sugihara et al. Mini-invasive Surg 2018;2:11 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.14

Original Article Open Access

A skill degradation in laparoscopic surgery after a
long absence: assessment based on nephrectomy
case

Toru Sugihara , Hideo Yasunaga , Hiroki Matsui , Akira Ishikawa , Tetsuya Fujimura , Hiroshi
3
4
2
2
1
Fukuhara , Kiyohide Fushimi , Yukio Homma , Haruki Kume 7
5
3
6
1 Department of Urology, Tokyo Metoropolitan Tama Medical Center, Fuchu 1838524, Japan.
2 Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo
1138654, Japan.
3 Department of Urology, Japanese Red Cross Medical Center, Tokyo 1508935, Japan.
4 Department of Urology, Jichi Medical University, Shimotuke 3290498, Japan.
5 Department of Urology, Kyorin University Hospital, Mitaka 1818611, Japan.
6 Department of Health Care Informatics, Tokyo Medical and Dental University, Tokyo 1138510, Japan.
7 Department of Urology, The University of Tokyo, Tokyo 1138654, Japan.
Correspondence to: Dr. Toru Sugihara, Department of Urology, Tokyo Metoropolitan Tama Medical Center, Fuchu 1838524,
Japan. E-mail: ezy04707@nifty.com
How to cite this article: Sugihara T, Yasunaga H, Matsui H, Ishikawa A, Fujimura T, Fukuhara H, Fushimi K, Homma Y, Kume H.
A skill degradation in laparoscopic surgery after a long absence: assessment based on nephrectomy case. Mini-invasive Surg
2018;2:11. http://dx.doi.org/10.20517/2574-1225.2018.14

Received: 20 Mar 2018 First Decision: 4 Apr 2018 Revised: 26 Apr 2018 Accepted: 2 May 2018 Published: 14 May 2018
Science Editor: Richard Lawrence John Naspro Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Aim: To examine the laparoscopic skill-degradation effect by investigating whether a long absence from laparoscopic
surgery increases laparoscopic surgery time.

Methods: Using the Japanese Diagnosis Procedure Combination database from April 2010 to March 2012, data for
patients undergoing laparoscopic nephrectomy and nephroureterectomy for malignancy were collected. To regulate
the hospital volume effect, the hospitals included in the study were limited to those with hospital volumes of 12-24 per
year. Laparoscopic time was assessed by multivariate linear regression analysis including interval days, age, gender,
comorbidity, oncological stage, nephrectomy or nephroureterectomy, hospital academic status, and hospital volume.

Results: For intervals of ≥ 7 days (3057 cases), 8-14 days (1325 cases), 15-28 days (1424 cases), 29-56 days (711 cases),
and ≤ 57 days (332 cases), the median laparoscopic times were 245, 247, 255, 265, and 260 min, respectively (P <
0.001). In multivariate analyses for laparoscopic time compared with interval of ≥ 7 days, 15-28 days, 29-56 days and ≤
57 days were associated with slightly longer laparoscopic time (+10.5, +16.8, and +18.8 min, all P < 0.01, respectively).

Conclusion: Absence intervals of ≤ 15 days can slightly lengthen the operation time, which suggest the existence of mild
© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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