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 following a 12 month LRP Fellowship in a high volume centre by the primary surgeon (MLJ). A training case was defined as the successful completion of at least 2 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 fifty patient cohorts.
RESULTS: 31% of cases were training cases with a median of 7 (Range 2-10) of 10 steps performed by the training Fellow. Operative times were significantly longer in training cases (mean 269 vs 209 mins) p< 0.0001. 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 (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 have been unaffected by trainee involvement.
Written by:
Luke S, Delprado W, Louie-Johnsun M. Are you the author?
Department of Urology, Gosford Hospital and Gosford Private Hospital, NSW, Australia.
Reference: BJU Int. 2014 May 13. Epub ahead of print.
doi: 10.1111/bju.12799
PubMed Abstract
PMID: 24825242
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