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Laparoscopic radical prostatectomy: decreasing the learning curve using a mentor initiated approach.
J Urol. 2003 Jun; 169(6):2063-5.JU

Abstract

PURPOSE

Laparoscopic radical prostatectomy is being evaluated at several centers in the United States as a treatment option for localized prostate cancer. It is a technically difficult operation to perform with a steep learning curve. It has been stated that 50 procedures are necessary to satisfy the learning curve. To expedite performance and evaluation of laparoscopic radical prostatectomy a surgeon (mentor) who had performed 200 cases was invited to instruct a fellowship trained laparoscopist (trainee).

MATERIALS AND METHODS

From March 2001 through September 2001 we performed 30 laparoscopic radical prostatectomies. The mentor performed the first 12 procedures with the trainee acting as assistant (group 1). The subsequent 18 procedures were performed by the trainee with the mentor acting as assistant (group 2). A final set of 20 procedures was performed by the trainee alone using 1 of 3 urological residents as the assistant (group 3). The transperitoneal approach was used and all suturing was intracorporeal. Preoperative data included prostate specific antigen, clinical stage, Gleason grade and median patient age. Intraoperative data included operative time, the blood loss/transfusion rate and intraoperative complications. Postoperative data included pathological stage, prostate specific antigen, the positive margin rate, catheter dwell time and hospital stay. When applicable, statistical significance was determined using the standard paired t test.

RESULTS

There was no statistical difference in median operative time in groups 1 and 2 (248 and 258 minutes, respectively, p = 0.15). Similarly there was no difference in groups 2 (trainee and mentor assistant) and 3 (trainee alone) (p = 0.26). There was a difference in operative time in groups 1 and 3 (p = 0.04). Mean estimated blood loss was comparable in groups 1 to 3 and not statistically different (150, 250 and 250 cc, respectively, p = 0.15). Mean organ weight was also comparable (64, 59 and 55 gm., respectively). Hospital stay was 3 days in all groups. Catheter time decreased as confidence was gained with the procedure (range 6 to 33 days). Final pathological stage was compared among the 3 groups. There was an overall increase in positive margins in groups 1 to 3 (16%, 22% and 30%, respectively, p not significant). However, the positive margin rate for stage pT2 disease was similar at 15.5% for groups 1 and 2, and 14% for group 3.

CONCLUSIONS

Laparoscopic radical prostatectomy is a technically challenging operation that is in the early stages of evolution and evaluation. We present an intensive, mentor initiated approach to decrease the learning curve and maintain outcomes.

Authors+Show Affiliations

Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia 23454, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12771720

Citation

Fabrizio, Michael D., et al. "Laparoscopic Radical Prostatectomy: Decreasing the Learning Curve Using a Mentor Initiated Approach." The Journal of Urology, vol. 169, no. 6, 2003, pp. 2063-5.
Fabrizio MD, Tuerk I, Schellhammer PF. Laparoscopic radical prostatectomy: decreasing the learning curve using a mentor initiated approach. J Urol. 2003;169(6):2063-5.
Fabrizio, M. D., Tuerk, I., & Schellhammer, P. F. (2003). Laparoscopic radical prostatectomy: decreasing the learning curve using a mentor initiated approach. The Journal of Urology, 169(6), 2063-5.
Fabrizio MD, Tuerk I, Schellhammer PF. Laparoscopic Radical Prostatectomy: Decreasing the Learning Curve Using a Mentor Initiated Approach. J Urol. 2003;169(6):2063-5. PubMed PMID: 12771720.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic radical prostatectomy: decreasing the learning curve using a mentor initiated approach. AU - Fabrizio,Michael D, AU - Tuerk,Ingolf, AU - Schellhammer,Paul F, PY - 2003/5/29/pubmed PY - 2003/6/11/medline PY - 2003/5/29/entrez SP - 2063 EP - 5 JF - The Journal of urology JO - J Urol VL - 169 IS - 6 N2 - PURPOSE: Laparoscopic radical prostatectomy is being evaluated at several centers in the United States as a treatment option for localized prostate cancer. It is a technically difficult operation to perform with a steep learning curve. It has been stated that 50 procedures are necessary to satisfy the learning curve. To expedite performance and evaluation of laparoscopic radical prostatectomy a surgeon (mentor) who had performed 200 cases was invited to instruct a fellowship trained laparoscopist (trainee). MATERIALS AND METHODS: From March 2001 through September 2001 we performed 30 laparoscopic radical prostatectomies. The mentor performed the first 12 procedures with the trainee acting as assistant (group 1). The subsequent 18 procedures were performed by the trainee with the mentor acting as assistant (group 2). A final set of 20 procedures was performed by the trainee alone using 1 of 3 urological residents as the assistant (group 3). The transperitoneal approach was used and all suturing was intracorporeal. Preoperative data included prostate specific antigen, clinical stage, Gleason grade and median patient age. Intraoperative data included operative time, the blood loss/transfusion rate and intraoperative complications. Postoperative data included pathological stage, prostate specific antigen, the positive margin rate, catheter dwell time and hospital stay. When applicable, statistical significance was determined using the standard paired t test. RESULTS: There was no statistical difference in median operative time in groups 1 and 2 (248 and 258 minutes, respectively, p = 0.15). Similarly there was no difference in groups 2 (trainee and mentor assistant) and 3 (trainee alone) (p = 0.26). There was a difference in operative time in groups 1 and 3 (p = 0.04). Mean estimated blood loss was comparable in groups 1 to 3 and not statistically different (150, 250 and 250 cc, respectively, p = 0.15). Mean organ weight was also comparable (64, 59 and 55 gm., respectively). Hospital stay was 3 days in all groups. Catheter time decreased as confidence was gained with the procedure (range 6 to 33 days). Final pathological stage was compared among the 3 groups. There was an overall increase in positive margins in groups 1 to 3 (16%, 22% and 30%, respectively, p not significant). However, the positive margin rate for stage pT2 disease was similar at 15.5% for groups 1 and 2, and 14% for group 3. CONCLUSIONS: Laparoscopic radical prostatectomy is a technically challenging operation that is in the early stages of evolution and evaluation. We present an intensive, mentor initiated approach to decrease the learning curve and maintain outcomes. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/12771720/Laparoscopic_radical_prostatectomy:_decreasing_the_learning_curve_using_a_mentor_initiated_approach_ L2 - https://www.jurology.com/doi/10.1097/01.ju.0000059701.01781.e4?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -