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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 degree of a skill-degradation effect in laparoscopic surgery.

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