title: Laparoscopic radical prostatectomy: the learning curve of a low volume surgeon.
abstract: OBJECTIVE
  Analyze the learning curve for laparoscopic radical prostatectomy in a low volume program.
  
  
  METHODS
  A single surgeon operated on 165 patients. Patients were consecutively divided in 3 groups of 55 patients (groups A, B, and C). An enhancement of estimated blood loss, surgery length, and presence of a positive surgical margin were all considered as a function of surgeon's experience.
  
  
  RESULTS
  Operative time was 267 minutes for group A, 230 minutes for group B, and 159 minutes for group C, and the operative time decreased over time, but a significant difference was present only between groups A and C (P < 0.001). Mean estimated blood loss was 328 mL, 254 mL, and 206 mL (P = 0.24). A conversion to open surgery was necessary in 4 patients in group A. Positive surgical margin rates were 29.1%, 21.8%, and 5.5% (P = 0.02). Eight patients in group A, 4 patients in group B, and one in group C had biochemical recurrence.
  
  
  CONCLUSIONS
  Significantly less intraoperative complications were evident after the first 51 cases. All other parameters (blood loss, operative time, and positive surgical margins) significantly decreased and stabilized after 110 cases. Those outcomes were somehow similar to previous published series by high-volume centers.
authors.affiliation: Division of Urology, University of São Paulo, 05403 Sao Paulo, SP, Brazil.
authors.forename: Anuar I
authors.initials: AI
authors.lastname: Mitre
authors.forename: Mario F
authors.initials: MF
authors.lastname: Chammas
authors.forename: José Eugênio A
authors.initials: JE
authors.lastname: Rocha
authors.forename: Ricardo Jordão
authors.initials: RJ
authors.lastname: Duarte
authors.forename: Gustavo Xavier
authors.initials: GX
authors.lastname: Ebaid
authors.forename: Flavio Trigo
authors.initials: FT
authors.lastname: Rocha
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010820:Physicians; D011446:Prospective Studies; D011468:Prostatectomy / Q000193:education / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome