Introduction and Objectives
Exstraperitoneal laparoscopic radical prostatectomy (ELRP) is a technically exacting operative procedure. We demonstrate our center's learning curve.
Material and Methods
Between April 2005 and May 2009, 554 consecutive men with a mean age of 64.1 (range 47–72), a mean pre-operative PSA of 5.9 ng/ml and clinically localized prostate cancer underwent ELRP by six urologists at General Hospital Slovenj Gradec. Urologist I and II are senior surgeons that have extensive experience from transperitoneal laparoscopic radical prostatectomy and other laparoscopic procedures, urologist III has medium laparoscopic experience and other three urologists (IV–VI) have a little experience in laparoscopy. Operative time, estimated blood-loss and positive surgical margin rate were noted. All urologists assisted more than 100 transperitoneal laparoscopic radical prostatectomies before starting with ELRP. In order to our study the patients were divided into four subgroups consisting of the first 50 patients operated, the next 100, 150 and other 254 patients.
Results
In 5 patients the conversion was needed because of major bleeding. 11 complications required reoperation: 3 recto-vesical fistula, 1 rectal injury, 2 major bleeding and 5 anastomosis failure. There was no per-operative or postoperative mortality. Pathological stage was pT2 in 69.2% and pT3 in 30.8% tumors. Urologist I performed 178 operative procedures, urologist II 243, urologist III 54, urologist IV 42, urologist V 28 and urologist VI performed 9 procedures. Results of operative time, estimated blood-loss and positive surgical margin rate for all urologists are shown in the table.
Tabled
1
| Successive patients | Mean operative time (min) | Estimated blood-loss (ml) | Positive surgical margin rate (%) |
|---|---|---|---|
| 1–50 | 150 | 280 | 33.2 |
| 51–150 | 140 | 237 | 26.1 |
| 151–300 | 149 | 206 | 19.4 |
| 301–554 | 138 | 163 | 15.3 |
| 1–554 | 143 | 198 | 19.9 |
Conclusions
There is an ongoing learning curve concerning mean operative time, estimated blood-loss and positive surgical margin rate even after more than 100 cases per urologist.
Article info
Identification
Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
