title: Laparoscopic radical prostatectomy outcome data: how should surgeon's performance be reported? A retrospective learning curve analysis of two surgeons.
abstract: OBJECTIVE
  To document the learning curve for the laparoscopic radical prostatectomy (LRP) procedure and discuss the optimal usage of prospectively documented outcome data for reporting a surgeon's performance.
  
  
  METHODS
  Using prospectively collected data from the first series of patients to undergo LRP by two surgeons in the same institution, linear and logistic regression multivariate analyses per 25 patients were carried out to graphically represent the surgical learning curve for operative time, blood loss, complications, length of stay (LOS), and positive margins. Surgeon A carried out 275 operations between 2003-2009; Surgeon B carried out 225 between 2008-2012.
  
  
  RESULTS
  Learning curves showing continuous improvement of each of the above outcomes were demonstrated for both cohorts. For surgeon A, a plateau was observed for LOS and T2 positive margins after 100 and 150 surgeries respectively. No such plateau was observed for surgeon B.
  
  
  CONCLUSIONS
  On documenting these learning curves and discussion of the reporting methods used, we concluded that the most informative outcome measure, with the least potential observer bias was T2 positive margins. Whether as a single measure or in combination with others, this has potential for use as an objective outcome representative of improvement in a surgeon's skill over time.
authors: King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London, UK.
authors: Sarah
authors: S
authors: Mason
authors: King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London, UK.
authors: Mieke
authors: M
authors: Van Hemelrijck
authors: King's Health Partners, London SE1 9RT, UK.
authors: Ashish
authors: A
authors: Chandra
authors: King's Health Partners, London SE1 9RT, UK.
authors: Christian
authors: C
authors: Brown
authors: King's Health Partners, London SE1 9RT, UK; Royal Marsden Hospital, London SW3 6JJ, UK.
authors: Declan
authors: D
authors: Cahill
keywords: learning curve; patient outcome assessment; prostatectomy; prostatic neoplasms; surgeons