title: Laparoscopic radical prostatectomy. Impact of the learning curve on positive surgical margins.
abstract: OBJECTIVE
  The study was conducted to assess the incidence of positive surgical margins (PSMs ) in our series of laparoscopic radical prostatectomy (LRP ) performed by a fellowship trained surgeon in independent practice.
  
  
  METHODS
  In this series, 300 patients underwent LRP by the same surgeon at our institution. The prospectively created records of all consecutive LRPs were reviewed. The patients were divided into three groups based on the time of surgery: group I included the first 100 cases;group II included the second 100 cases; and group III the last 100 cases. We compared the incidence rate and the location of PSMs among the groups. As additional variables, prostate-specific antigen (PSA ) level, biopsy/specimen Gleason score, clinical/pathological stage and pathologic tumor volume were also evaluated.
  
  
  RESULTS
  Patient demographics and preoperative staging variables were comparable among the three groups, with no statistically significant differences among them. The PSM rates were 27%, 22% and 27% for groups I, II and III, respectively. The difference in overall PSM rates in the three groups was statistically insignificant (p: 0.966 ) . PSM rates decreased specifically at the posterolateral region and in pT3b stage with non/significant difference when comparing the first 100 patients to the last 100 patients.
  
  
  CONCLUSIONS
  Pathologic surgical margin safety can be achieved with laparoscopic fellowship/training (LFT ) from the initial cases in independent practice.
authors.affiliation: Department of Urology, Memorial Istanbul Atasehir Hospital, Istanbul, Turkey. dr@tibeterdogru.com
authors.forename: Tibet
authors.initials: T
authors.lastname: Erdogru
authors.forename: Orçun
authors.initials: O
authors.lastname: Celik
authors.forename: Murat
authors.initials: M
authors.lastname: Akand
authors.forename: Yigit
authors.initials: Y
authors.lastname: Akin
authors.forename: Ali Feyzullah
authors.initials: AF
authors.lastname: Sahin
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Ciftcioglu
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002983:Clinical Competence; D005257:Fellowships and Scholarships; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D059032:Learning Curve; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000032:analysis; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen