Laparoscopic radical prostatectomy: Six months of fellowship training doesn't prevent the learning curve when incorporating into a lower volume practice
ABSTRACT To assess whether 6 months of standard laparoscopic radical prostatectomy (LRP) training reduces the learning curve.
A single urologist (JAB) performed two 3-month fellowships at medical centers with high-volume LRP surgeons (Thomas Jefferson University, 2002 and Massachusetts General Hospital, 2003). He participated in 29 transperitoneal and 23 extraperitoneal LRPs, performing part or all (2) of 28 cases. He subsequently initiated a LRP program at our institution in July 2003, performing 32 procedures between July 2003 and June 2006 (excluding a 3-month 2004 robotic surgery sabbatical). Six residents served as assistant.
Median patient age, BMI, and preoperative PSA were 58 (46-71) years, 30 (21-37), and 5.4 (3.2-13.6) ng/ml, respectively. Median estimated blood loss (EBL) and operative time were 400 (50-1700) ml and 411 (282-652) minutes. Median hospital stay, catheterization, and follow-up were 2 (1-12) days, 15 (8-52) days, and 10 (1-30) months, respectively. Ten (31%) and 6 (19%) underwent pelvic lymphadenectomy and open conversion. Five patients (16%) received transfusion. Twenty-three (72%) were pathologic stage pT2 and 9 (28%) pT3. Thirteen, 15, and 3 specimens were Gleason 6, 7, and > or =8, respectively. Fifteen (47%) had positive surgical margins (14 apical and 7 other sites). Nineteen (59%) had complications and 4 (12.5%) salvage radiation therapy. Of 20 patients followed 12 months, 12 (60%) are continent (pad free) and 4 (27%) potent patients remain so with or without PDE5 inhibitor.
Six months of training (52 cases, 28 as surgeon for part or all) did not alleviate the LRP learning curve.
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ABSTRACT: Despite increased utilization of Minimally Invasive Radical Prostatectomy (MIRP), open conversion (OC) may occur due to surgical complications, surgeon inexperience or failure to progress. Here we use nationally representative data to quantify the impact of OC compared to nonconverted MIRP and open radical prostatectomy (ORP) and identify predictors of OC.The Journal of Urology 06/2014; 192(6). DOI:10.1016/j.juro.2014.06.029 · 3.75 Impact Factor
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ABSTRACT: Laparoscopic radical prostatectomy (LRP) has a long learning curve; however, little is known about the pentafecta learning curve for LRP. We analysed the learning curve for a fellowship trained surgeon with regard to the pentafecta with up to 6-year follow-up. A retrospective review was performed in 550 cases, by dividing these cases into 11 groups of 50 patients. Outcomes analysed were the following: (1) the pentafecta (complication rate, positive surgical margin (PSM) rate, continence, potency and biochemical recurrence); (2) operative time and blood loss; and (3) overall pentafecta attainment. The mean complication rate for the entire series was 9 %; this plateaued after 150 cases. The overall PSM rate for the series was 23.5 %, 16.3 % for pT2 and 40.5 % for pT3. PSM plateaued after 200 cases. Excluding the first 100 cases, the overall PSM rate for pT2 was 10.9 % and 37.8 % for pT3. The continence rate stabilised after approximately 250 cases. The rate of male sling/artificial urinary sphincter plateaued after 200 cases. The potency learning curve continues to improve after 250 cases of nerve-sparing (ns) endoscopic extraperitoneal radical prostatectomy (EERPE) as does the pentafecta learning curve which closely follows the pattern of the potency learning curve. The last group of nsEERPE achieved pentafecta in 63 %. This study shows multiple learning curves: an initial for peri-operative outcomes, then stabilisation of oncologic outcomes and the final for stabilisation of functional outcomes. In this series over 250 cases were required to achieve the learning curve.World Journal of Urology 12/2013; 32(5). DOI:10.1007/s00345-013-1198-9 · 3.42 Impact Factor
ANZ Journal of Surgery 03/2012; 82(3):99. DOI:10.1111/j.1445-2197.2011.05985.x · 1.12 Impact Factor