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Title: Teaching laparoscopic radical prostatectomy during the primary surgeon's early learning curve--analysis of our first 207 cases
Authors: Louie-Johnsun, Mark ;Luke, Serge ;Delprado, W.
Issue Date: Nov-2014
Source: Volume 114 Suppl 1, pp. 38 - 44
Journal title: BJU International
Abstract: OBJECTIVE: To assess the feasibility of introducing laparoscopic radical prostatectomy (LRP) training during the primary surgeon's early learning curve in a regional Australian centre. PATIENTS AND METHODS: From a prospective single surgeon database perioperative, oncological and functional outcome data was collected from the first 207 consecutive patients who underwent LRP immediately after a 12-month LRP Fellowship in a high-volume centre by the primary surgeon (M.L.J.). A training case was defined as the successful completion of at least two of 10 steps by a training Fellow. Perioperative and oncological outcomes were compared in training and non-training cohorts and overall learning curve was assessed by comparing consecutive 50-patient cohorts. RESULTS: In all, 31% of cases were training cases with a median (range) of 7 (2-10) steps of 10 steps performed by the training Fellow. Operative times were significantly longer in training cases (mean 269 vs 209 min; P < 0.001). There was no statistically significant difference in perioperative outcomes of length of stay (2.7 vs 2.6 days), transfusion rates (3.1% vs 2.1%), major complication (Clavien >3a) rates (1.6% vs 2.1%) or positive surgical margins (PSMs: pT2 2.8% vs 15.3% and pT3 52.0% vs 45.1%) between training and non-training groups, respectively. Overall, there were two open conversions (1.0%). CONCLUSION: Despite the challenging learning curve, LRP training can be commenced safely with a stepwise modular approach, even when the primary surgeon is in their early learning curve. Perioperative outcomes including PSMs and major complications were unaffected by trainee involvement.
DOI: 10.1111/bju.12799
ISSN: 1464-4096
Publicaton type: Journal Article
Keywords: Cancer
Study or Trial: Prospective Cohort Study
Appears in Collections:Health Service Research

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