title: Complications in 2200 consecutive laparoscopic radical prostatectomies: standardised evaluation and analysis of learning curves.
abstract: BACKGROUND
  Laparoscopic radical prostatectomy (LRP) represents an established treatment modality for localised prostate cancer.
  
  
  OBJECTIVE
  To report standardised complication rates for LRP, evaluate the development of complication rates over time, and show changes within the learning curves of laparoscopic surgeons.
  
  
  METHODS
  We conducted a standardised analysis of 2200 consecutive patients who underwent LRP between 1999 and 2008 at a single institution.
  
  
  METHODS
  LRP was performed using a transperitoneal (n=871) or extraperitoneal (n=1329) retrograde Heilbronn technique. Five surgeons operated on 96% of the patients.
  
  
  METHODS
  Complications were classified according to the modified Clavien system. Total complication rates and changes over time were analysed. Three generations of surgeons were defined for evaluation of learning curves.
  
  
  CONCLUSIONS
  Minor complications occurred in 21.7% of patients (Clavien 1: 6.8%; Clavien 2: 14.9%); anaemia requiring transfusion (10.4%) dominated. Early reinterventions were necessary in 6.7% of patients (Clavien 3a: 3.6%; Clavien 3b: 1.5%; Clavien 4a: 1.5%; Clavien 4b: 0.1%). Late Clavien 3b complications occurred in 4.7% of patients-most of them anastomotic strictures. Mortality was 0.1% (Clavien 5). There was a significant decrease in overall complication rates over time, resulting predominantly from decreasing Clavien 1-2 events. Learning curves of third-generation surgeons plateaued earlier compared to the first generation (250 vs 700 cases). The limitation of this study is that data concerning comorbidity were not included.
  
  
  CONCLUSIONS
  LRP is a safe procedure characterised by an acceptable profile of complications. Specifically, few major complications are reported. According to the complication rates, the learning curve of third-generation surgeons is significantly shorter compared to first- and second-generation surgeons.
authors.affiliation: Department of Urology, SLK-Kliniken Heilbronn, Heilbronn, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Hruza
authors.forename: Hagen O
authors.initials: HO
authors.lastname: Weiss
authors.forename: Giovannalberto
authors.initials: G
authors.lastname: Pini
authors.forename: Ali S
authors.initials: AS
authors.lastname: Goezen
authors.forename: Michael
authors.initials: M
authors.lastname: Schulze
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
authors.forename: Jens J
authors.initials: JJ
authors.lastname: Rassweiler
mesh_terms: D000368:Aged; D004502:Education, Medical, Continuing / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D013502:General Surgery / Q000193:education* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000193:education / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification* / Q000401:mortality / Q000473:pathology; D011237:Predictive Value of Tests; D011468:Prostatectomy / Q000009:adverse effects* / Q000193:education / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*