ABSTRACT
STUDY OBJECTIVE: To evaluate the effect of diameter of the endoscope on the duration and quality of laparoscopic surgery. DESIGN: Prospective, randomized trial (Canadian Task Force classification I). SETTING: Centre for Surgical Technologies. SUBJECTS: Sixty adult, female, New Zealand, white rabbits. INTERVENTION: Two series of laparoscopic nephrectomies, one each performed by an experienced and an inexperienced surgeon comparing 10-, 5-, 4-, and 2-mm endoscopes. MEASUREMENTS AND MAIN RESULTS: Besides duration of surgery and occurrence of bleeding, the quality of dissection was scored by adding scores of dissection of renal vessels, ureters, and kidneys. During consecutive nephrectomies, the duration of surgery (p = 0. 001) and occurrence of bleeding (p = 0.02) decreased, whereas the quality of dissection increased (p = 0.002), demonstrating the learning curve, mainly for the less experienced surgeon. Duration of surgery (p = 0.04) decreased and quality of dissection increased (p = 0.05) when the larger endoscope was used. This was the case only for the less experienced surgeon, whereas for the experienced surgeon it had only a slight effect on learning curve. CONCLUSION: These results confirm a learning curve of nephrectomy consisting of some 20 animals. In addition, the endoscope diameter and thus quality of image affect both duration and quality of surgery, especially for less experienced surgeons.
