Teaching laparoscopic radical prostatectomy during the primary surgeon's early learning curve--analysis of our first 207 cases.
OBJECTIVE
To assess the feasibility of introducing laparoscopic radical prostatectomy (LRP) training during the primary surgeon's early learning curve in a regional Australian centre.


METHODS
From a prospective single surgeon database perioperative, oncological and functional outcome data was collected from the first 207 consecutive patients who underwent LRP immediately after a 12-month LRP Fellowship in a high-volume centre by the primary surgeon (M.L.J.). A training case was defined as the successful completion of at least two of 10 steps by a training Fellow. Perioperative and oncological outcomes were compared in training and non-training cohorts and overall learning curve was assessed by comparing consecutive 50-patient cohorts.


RESULTS
In all, 31% of cases were training cases with a median (range) of 7 (2-10) steps of 10 steps performed by the training Fellow. Operative times were significantly longer in training cases (mean 269 vs 209 min; P < 0.001). There was no statistically significant difference in perioperative outcomes of length of stay (2.7 vs 2.6 days), transfusion rates (3.1% vs 2.1%), major complication (Clavien >3a) rates (1.6% vs 2.1%) or positive surgical margins (PSMs: pT2 2.8% vs 15.3% and pT3 52.0% vs 45.1%) between training and non-training groups, respectively. Overall, there were two open conversions (1.0%).


CONCLUSIONS
Despite the challenging learning curve, LRP training can be commenced safely with a stepwise modular approach, even when the primary surgeon is in their early learning curve. Perioperative outcomes including PSMs and major complications were unaffected by trainee involvement.
Department of Urology, Gosford Hospital and Gosford Private Hospital, Gosford, NSW, Australia.
Serge
S
Luke
Warick
W
Delprado
Mark
M
Louie-Johnsun
D001315:Australia; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D059032:Learning Curve; D011446:Prospective Studies; D011468:Prostatectomy / Q000193:education*; D066231:Surgeons / Q000193:education* / Q000592:standards
laparoscopic radical prostatectomy; learning curve; prostate cancer; training