[show abstract][hide abstract] ABSTRACT: It is not yet possible to estimate the number of cases required for a beginner to become expert in laparoscopic radical prostatectomy. We estimated the learning curve of laparoscopic radical prostatectomy for positive surgical margins compared to a published learning curve for open radical prostatectomy.
We reviewed records from 8,544 consecutive patients with prostate cancer treated laparoscopically by 51 surgeons at 14 academic institutions in Europe and the United States. The probability of a positive surgical margin was calculated as a function of surgeon experience with adjustment for pathological stage, Gleason score and prostate specific antigen. A second model incorporated prior experience with open radical prostatectomy and surgeon generation.
Positive surgical margins occurred in 1,862 patients (22%). There was an apparent improvement in surgical margin rates up to a plateau at 200 to 250 surgeries. Changes in margin rates once this plateau was reached were relatively minimal relative to the CIs. The absolute risk difference for 10 vs 250 prior surgeries was 4.8% (95% CI 1.5, 8.5). Neither surgeon generation nor prior open radical prostatectomy experience was statistically significant when added to the model. The rate of decrease in positive surgical margins was more rapid in the open vs laparoscopic learning curve.
The learning curve for surgical margins after laparoscopic radical prostatectomy plateaus at approximately 200 to 250 cases. Prior open experience and surgeon generation do not improve the margin rate, suggesting that the rate is primarily a function of specifically laparoscopic training and experience.
The Journal of urology 10/2010; 184(6):2291-6. · 4.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: Pelvic arteriovenous malformations (AVM) are rare, usually congenital, lesions, which can pose significant difficulties for pelvic surgeons. We present a case of an AVM complicating laparoscopic radical prostatectomy. Unexpected failure of preoperative control led to significant intraoperative difficulty. The advantages of an antegrade approach and optimal magnification afforded by the laparoscopic approach led to successful completion of the operation with minimal morbidity.
[show abstract][hide abstract] ABSTRACT: To investigate the effect of previous bladder outlet surgery (BOS) on the peri-operative variables of patients having laparoscopic radical prostatectomy (LRP), as reported evidence as to whether BOS affects the outcome of RP is contradictory.
Of 600 consecutive patients attending for LRP from March 2000 to January 2006, 558 had had no surgery (NS) and 42 (7.0%) had a history of BOS (transurethral prostatectomy in 35, 5.8%; bladder neck incision in seven, 1.2%). All patients had clinical stage < or = T3aN0M0 prostate cancer and had their procedure performed or supervised by the same surgeon.
Patients with previous BOS had a significantly greater age (mean 64.6 vs 61.8 years, P = 0.008), duration of catheterization (mean 13.7 vs 10.5 days, P = 0.003), proportion of pT3a tumours (16.7% vs 4.5%, P = 0.009) and potency rates at > or = 24 months (P < 0.001). Patients with previous BOS had a significantly lower body weight (mean 79.7 vs 83.0 kg, P = 0.05) and prostate weight (mean 46.7 vs 58.6 g, P = 0.01). Although patients with previous BOS had poorer continence at 3 months (61% vs 91%, P < 0.001), continence rates were similar in the two groups after this.
Previous BOS does not affect the medium-term outcomes after LRP.
BJU International 02/2007; 99(2):399-402. · 3.05 Impact Factor