title: Temporal relationship between positive margin rate after laparoscopic radical prostatectomy and surgical training.
abstract: OBJECTIVE
  To evaluate the potential impact of the experience of the first assistant on the positive surgical margin rate (PSMR) after laparoscopic radical prostatectomy (LRP). The impact of training surgical residents and fellows on patient outcomes is difficult to quantify.
  
  
  METHODS
  A single-institution prospective database of 303 patients who underwent LRP between 2003 and 2008 was evaluated. The potential impact of the experience of the first assistant on the PSMR was evaluated by examining the relationship between the PSMR and the time of the academic year. Multivariable logistic regression analysis was used to adjust for patient age, Gleason's sum, tumor density, and pathologic stage.
  
  
  RESULTS
  Overall positive margin rate was 18.2%. Positive margin rate for July and August (14/45, 31.1%) was significantly higher than for the remaining 10 months (41/258, 15.9%) P = .015. The increased risk of positive margin in July/August remained significant after adjusting for age, Gleason's sum, tumor density, and pathologic stage (OR 2.65, 95% CI 1.21-5.79, P = .015)
  
  
  CONCLUSIONS
  LRP performed with the first assistant in the first 2 months of the academic training year have a significantly higher PSMR.
authors.affiliation: Division of Urology, University of Kentucky, Lexington, KY, USA. jay.page@uky.edu
authors.forename: Jay B
authors.initials: JB
authors.lastname: Page
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Davenport
authors.forename: Raman
authors.initials: R
authors.lastname: Unnikrishnan
authors.forename: Paul L
authors.initials: PL
authors.lastname: Crispen
authors.forename: Ramakrishna
authors.initials: R
authors.lastname: Venkatesh
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Strup
mesh_terms: D002983:Clinical Competence; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000193:education* / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*