title: Analysis of the learning curve for transurethral resection of the prostate. Is there any influence of musical instrument and video game skills on surgical performance?
abstract: OBJECTIVE
  To evaluate the learning curve for transurethral resection of the prostate (TURP) among urology residents and study the impact of video game and musical instrument playing abilities on its performance.
  
  
  METHODS
  A prospective study was performed from July 2009 to January 2013 with patients submitted to TURP for benign prostatic hyperplasia. Fourteen residents operated on 324 patients. The following parameters were analyzed: age, prostate-specific antigen levels, prostate weight on ultrasound, pre- and postoperative serum sodium and hemoglobin levels, weight of resected tissue, operation time, speed of resection, and incidence of capsular lesions. Gender, handedness, and prior musical instrument and video game playing experience were recorded using survey responses.
  
  
  RESULTS
  The mean resection speed in the first 10 procedures was 0.36 g/min and reached a mean of 0.51 g/min after the 20(th) procedure. The incidence of capsular lesions decreased progressively. The operation time decreased progressively for each subgroup regardless of the difference in the weight of tissue resected. Those experienced in playing video games presented superior resection speed (0.45 g/min) when compared with the novice (0.35 g/min) and intermediate (0.38 g/min) groups (p=0.112). Musical instrument playing abilities did not affect the surgical performance.
  
  
  CONCLUSIONS
  Speed of resection, weight of resected tissue, and percentage of resected tissue improve significantly and the incidence of capsular lesions reduces after the performance of 10 TURP procedures. Experience in playing video games or musical instruments does not have a significant effect on outcomes.
authors.affiliation: Department of Urology, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Kleiton Gabriel Ribeiro
authors.initials: KG
authors.lastname: Yamaçake
authors.affiliation: Department of Urology, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Elcio Tadashi
authors.initials: ET
authors.lastname: Nakano
authors.affiliation: Department of Urology, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Iva Barbosa
authors.initials: IB
authors.lastname: Soares
authors.affiliation: Department of Urology, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Cordeiro
authors.affiliation: Department of Urology, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.affiliation: Department of Urology, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Alberto Azoubel
authors.initials: AA
authors.lastname: Antunes
keywords: Learning curve; music; prostate; surgery; video games