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Laparoscopic radical prostatectomy: reducing the learning curve.
Urology. 2008 Dec; 72(6):1347-50.U

Abstract

OBJECTIVES

To review the operative results of a single surgeon after a laparoscopic radical prostatectomy (LRP) fellowship to assess whether the LRP learning curve can be abbreviated.

METHODS

We undertook a prospective study of 50 men who underwent LRP performed by a recently graduated LRP fellowship-trained surgeon. The patient details, operative data, complications, and post-operative followup were collected over the initial 12-month period.

RESULTS

The median age was 63 years (range, 47 to 72 years) and median follow-up of 6 months (range, 1 to 12 months). The majority of patients had a preoperative clinical stage T1c (30 = 60%) with a median PSA of 6.4 ng/mL. The median operative time was 225 minutes (range, 160 to 360 minutes) and median blood loss was 400 mL. There were three major complications: 1 anastamotic revision and 2 bladder neck contractures. The positive surgical margin rate for pT2 disease was 5% and for pT3 disease was 20%. Continence rates were 87% at 12 months (no pad use); unilateral (14%) and bilateral nerve sparing (34%) yielded early return of potency in 37.5% of men. No conversions, no rectal injuries, and no deaths occurred in the series.

CONCLUSIONS

The learning curve that has been observed in other series is not seen with regard to operative time or complication rates. Crucially, it is not seen in a positive surgical margin rate. A dedicated fellowship in laparoscopic radical prostatectomy abbreviates the extensive learning curve for this most technically challenging procedure.

Authors+Show Affiliations

Department of Urology, Monash Medical Centre and Royal Melbourne Hospital, Victoria, Australia.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18400266

Citation

Hellawell, G O., and D A. Moon. "Laparoscopic Radical Prostatectomy: Reducing the Learning Curve." Urology, vol. 72, no. 6, 2008, pp. 1347-50.
Hellawell GO, Moon DA. Laparoscopic radical prostatectomy: reducing the learning curve. Urology. 2008;72(6):1347-50.
Hellawell, G. O., & Moon, D. A. (2008). Laparoscopic radical prostatectomy: reducing the learning curve. Urology, 72(6), 1347-50. https://doi.org/10.1016/j.urology.2007.12.027
Hellawell GO, Moon DA. Laparoscopic Radical Prostatectomy: Reducing the Learning Curve. Urology. 2008;72(6):1347-50. PubMed PMID: 18400266.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic radical prostatectomy: reducing the learning curve. AU - Hellawell,G O, AU - Moon,D A, Y1 - 2008/04/08/ PY - 2007/06/28/received PY - 2007/12/07/revised PY - 2007/12/07/accepted PY - 2008/4/11/pubmed PY - 2009/1/7/medline PY - 2008/4/11/entrez SP - 1347 EP - 50 JF - Urology JO - Urology VL - 72 IS - 6 N2 - OBJECTIVES: To review the operative results of a single surgeon after a laparoscopic radical prostatectomy (LRP) fellowship to assess whether the LRP learning curve can be abbreviated. METHODS: We undertook a prospective study of 50 men who underwent LRP performed by a recently graduated LRP fellowship-trained surgeon. The patient details, operative data, complications, and post-operative followup were collected over the initial 12-month period. RESULTS: The median age was 63 years (range, 47 to 72 years) and median follow-up of 6 months (range, 1 to 12 months). The majority of patients had a preoperative clinical stage T1c (30 = 60%) with a median PSA of 6.4 ng/mL. The median operative time was 225 minutes (range, 160 to 360 minutes) and median blood loss was 400 mL. There were three major complications: 1 anastamotic revision and 2 bladder neck contractures. The positive surgical margin rate for pT2 disease was 5% and for pT3 disease was 20%. Continence rates were 87% at 12 months (no pad use); unilateral (14%) and bilateral nerve sparing (34%) yielded early return of potency in 37.5% of men. No conversions, no rectal injuries, and no deaths occurred in the series. CONCLUSIONS: The learning curve that has been observed in other series is not seen with regard to operative time or complication rates. Crucially, it is not seen in a positive surgical margin rate. A dedicated fellowship in laparoscopic radical prostatectomy abbreviates the extensive learning curve for this most technically challenging procedure. SN - 1527-9995 UR - https://www.unboundmedicine.com/medline/citation/18400266/Laparoscopic_radical_prostatectomy:_reducing_the_learning_curve_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-4295(07)02596-4 DB - PRIME DP - Unbound Medicine ER -