The role of surgical experience impacts greatly on patient selection as well as reconstruction outcomes. A greater volume of cases will assist in helping the surgical team in selecting appropriate patients, allowing for familiarity and understanding of the process of pre-operation counseling, expected outcomes, and complications. In addition, a greater volume of cases allows for the familiarity with the procedure, which in turn, has been demonstrated to affect the subsequent quality of life outcomes.
To quantify the amount of experience required, we may investigate previous medical education studies in the field of learning curves in urology training. One particular review has highlighted that minimum requirement case numbers vary between procedures, for example, a robot-assisted radical cystectomy may require 16-30 cases before attaining proficiency. This suggests a minimal exposure of cases that would require years to achieve, if not being performed at a high-volume center. This demand for centralization of care to ensure high-volume caseloads resonates with other specialties in cancer care, such as in the management of pancreas or esophagus cancers.
In the context of a procedure with a continually evolving technique, we emphasize the importance of hospital and surgeon considerations for the selection of patients for ONB reconstructions.
Written by: Liang G Qu, MD, Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia and Nathan Lawrentschuk, MB, BS, PhD, FRACS, Associate Professor, University of Melbourne, Melbourne, Australia
References:
- Qu, Liang G., and Nathan Lawrentschuk. "Orthotopic Neobladder Reconstruction: Patient Selection And Perspectives." Research and Reports in Urology 11 (2019): 333.
- Kretschmer, Alexander, Tobias Grimm, Alexander Buchner, Christian G. Stief, and Alexander Karl. "Prognostic features for quality of life after radical cystectomy and orthotopic neobladder." International braz j urol 42, no. 6 (2016): 1109-1120.
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- Kretschmer, Alexander, Tobias Grimm, Alexander Buchner, Christian G. Stief, and Alexander Karl. "Prognostic features for quality of life after radical cystectomy and orthotopic neobladder." International braz j urol 42, no. 6 (2016): 1109-1120.
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