Approach to endoscopic extraperitoneal radical prostatectomy (EERPE): the impact of previous laparoscopic experience on the learning curve.
BACKGROUND
We report our approach regarding the technique of endoscopic extraperitoneal radical prostatectomy (EERPE) and analyze the learning curve of two surgeons after thorough technical training under expert monitoring. The purpose of this study was to investigate the influence of expert monitoring on the surgical outcome and whether previous laparoscopic experience influences the surgeon's learning curve.


METHODS
EERPE was performed on 120 consecutive patients by two surgeons with different experience in laparoscopy. An analysis and comparison of their learning curve was made.


RESULTS
Median operation time: 200 (110-415) minutes.


RESULTS
no conversion, blood transfusion (1.7%), rectal injury (3.3%). Median catheterisation time: 6 (5-45) days. Histopathological data: 55% pT2, 45% pT3 with a positive surgical margin rate of 6.1% and 46%, respectively. After 12 months, 78% of the patients were continent, 22% used 1 or more pad. Potency rate with or without PDE-5-inhibitors was 66% with bilateral and 31% with unilateral nerve-sparing, respectively. Operation time was the only parameter to differ significantly between the two surgeons.


CONCLUSIONS
EERPE can be learned within a short teaching phase. Previous laparoscopic experience is reflected by shorter operation times, not by lower complication rates or superior early oncological data.
Blana
Andreas
A
Department of Urology, University of Regensburg, St Josef's Hospital, Regensburg, Germany. blana@web.de <blana@web.de>
Straub
Markus
M
Wild
Peter J
PJ
Lunz
Jens C
JC
Bach
Thorsten
T
Wieland
Wolf F
WF
Ganzer
Roman
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000193:education; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008611:Mentors; D008875:Middle Aged; D011361:Professional Competence; D011468:Prostatectomy / Q000193:education* / Q000379:methods*; D012086:Reoperation / Q000193:education* / Q000379:methods; D013647:Task Performance and Analysis; D013663:Teaching; D016896:Treatment Outcome