Laparoscopic radical prostatectomy: prospective evaluation of the learning curve.
OBJECTIVE
We prospectively evaluated the learning curve (LC) of laparoscopic radical prostatectomy (L-RPE) regarding the improvements in operative times (OT) and technical difficulty in one-operator-practice as it compares with open RPE.


METHODS
Over 18 months, 50 L-RPE were performed by an inexperienced surgeon in laparoscopy but skilled in open surgery. Difficulty scores were obtained at the completion of each L-RPE comparing L-RPE to open RPE. OT, estimated blood loss (EBL), length of stay, and catheterization time were also obtained.


RESULTS
In the ablative part of L-RPE the median difficulty score was significantly higher (p<0.001) for the first 10 cases, decreased dramatically by case 11 becoming equivalent (p=0.3) to open RPE and by case 31 the L-RPE becomes significantly easier than open RPE (p=0.002). The difficulty scores for the urethrovesical anastomosis performance is always uniformly higher for the whole patient series (p<0.001). Median OT decreased significantly from 293 minutes in the first 10 cases to 114 minutes in the last 10 cases (p<0.001). Catheterization time and length of hospitalization, decreased significantly with the progression of the LC. EBL remained stable throughout the patient cases. Obesity, prior surgery, and extension of the procedure (lymphadenectomy, nerve-sparing) significantly increased the OT.


CONCLUSIONS
Although the ablative part of L-RPE has a relatively short LC for a skilled open surgeon reflected by the rapid decrease in difficulty scores and OT by case 21, the performance of anastomosis shows a longer LC. Intensive training on anastomosis may be necessary to master this skill.
Poulakis
Vassilis
V
Department of Urology and Pediatric Urology, Krankenhaus Nordwest, Teaching Hospital of the Johann-Wolfgang-Goethe-University Frankfurt, Steinbacher Hohl 2-26, D-60488 Frankfurt am Main, Germany. vpoulakis@aol.com
Dillenburg
Wolfgang
W
Moeckel
Matthias
M
de Vries
Rachelle
R
Witzsch
Ulrich
U
Zumbé
Jürgen
J
Rassweiler
Jens
J
Becht
Eduard
E
D000368:Aged; D002983:Clinical Competence; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000193:education* / Q000379:methods / Q000706:statistics & numerical data*