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The learning curve for laparoscopic radical prostatectomy: an international multicenter study.
J Urol. 2010 Dec; 184(6):2291-6.JU

Abstract

PURPOSE

It is not yet possible to estimate the number of cases required for a beginner to become expert in laparoscopic radical prostatectomy. We estimated the learning curve of laparoscopic radical prostatectomy for positive surgical margins compared to a published learning curve for open radical prostatectomy.

MATERIALS AND METHODS

We reviewed records from 8,544 consecutive patients with prostate cancer treated laparoscopically by 51 surgeons at 14 academic institutions in Europe and the United States. The probability of a positive surgical margin was calculated as a function of surgeon experience with adjustment for pathological stage, Gleason score and prostate specific antigen. A second model incorporated prior experience with open radical prostatectomy and surgeon generation.

RESULTS

Positive surgical margins occurred in 1,862 patients (22%). There was an apparent improvement in surgical margin rates up to a plateau at 200 to 250 surgeries. Changes in margin rates once this plateau was reached were relatively minimal relative to the CIs. The absolute risk difference for 10 vs 250 prior surgeries was 4.8% (95% CI 1.5, 8.5). Neither surgeon generation nor prior open radical prostatectomy experience was statistically significant when added to the model. The rate of decrease in positive surgical margins was more rapid in the open vs laparoscopic learning curve.

CONCLUSIONS

The learning curve for surgical margins after laparoscopic radical prostatectomy plateaus at approximately 200 to 250 cases. Prior open experience and surgeon generation do not improve the margin rate, suggesting that the rate is primarily a function of specifically laparoscopic training and experience.

Authors+Show Affiliations

Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

20952022

Citation

Secin, Fernando P., et al. "The Learning Curve for Laparoscopic Radical Prostatectomy: an International Multicenter Study." The Journal of Urology, vol. 184, no. 6, 2010, pp. 2291-6.
Secin FP, Savage C, Abbou C, et al. The learning curve for laparoscopic radical prostatectomy: an international multicenter study. J Urol. 2010;184(6):2291-6.
Secin, F. P., Savage, C., Abbou, C., de La Taille, A., Salomon, L., Rassweiler, J., Hruza, M., Rozet, F., Cathelineau, X., Janetschek, G., Nassar, F., Turk, I., Vanni, A. J., Gill, I. S., Koenig, P., Kaouk, J. H., Martinez Pineiro, L., Pansadoro, V., Emiliozzi, P., ... Guillonneau, B. (2010). The learning curve for laparoscopic radical prostatectomy: an international multicenter study. The Journal of Urology, 184(6), 2291-6. https://doi.org/10.1016/j.juro.2010.08.003
Secin FP, et al. The Learning Curve for Laparoscopic Radical Prostatectomy: an International Multicenter Study. J Urol. 2010;184(6):2291-6. PubMed PMID: 20952022.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The learning curve for laparoscopic radical prostatectomy: an international multicenter study. AU - Secin,Fernando P, AU - Savage,Caroline, AU - Abbou,Claude, AU - de La Taille,Alexandre, AU - Salomon,Laurent, AU - Rassweiler,Jens, AU - Hruza,Marcel, AU - Rozet,François, AU - Cathelineau,Xavier, AU - Janetschek,Gunther, AU - Nassar,Faissal, AU - Turk,Ingolf, AU - Vanni,Alex J, AU - Gill,Inderbir S, AU - Koenig,Philippe, AU - Kaouk,Jihad H, AU - Martinez Pineiro,Luis, AU - Pansadoro,Vito, AU - Emiliozzi,Paolo, AU - Bjartell,Anders, AU - Jiborn,Thomas, AU - Eden,Christopher, AU - Richards,Andrew J, AU - Van Velthoven,Roland, AU - Stolzenburg,Jens-Uwe, AU - Rabenalt,Robert, AU - Su,Li-Ming, AU - Pavlovich,Christian P, AU - Levinson,Adam W, AU - Touijer,Karim A, AU - Vickers,Andrew, AU - Guillonneau,Bertrand, Y1 - 2010/10/16/ PY - 2010/04/05/received PY - 2010/10/19/entrez PY - 2010/10/19/pubmed PY - 2010/12/31/medline SP - 2291 EP - 6 JF - The Journal of urology JO - J. Urol. VL - 184 IS - 6 N2 - PURPOSE: It is not yet possible to estimate the number of cases required for a beginner to become expert in laparoscopic radical prostatectomy. We estimated the learning curve of laparoscopic radical prostatectomy for positive surgical margins compared to a published learning curve for open radical prostatectomy. MATERIALS AND METHODS: We reviewed records from 8,544 consecutive patients with prostate cancer treated laparoscopically by 51 surgeons at 14 academic institutions in Europe and the United States. The probability of a positive surgical margin was calculated as a function of surgeon experience with adjustment for pathological stage, Gleason score and prostate specific antigen. A second model incorporated prior experience with open radical prostatectomy and surgeon generation. RESULTS: Positive surgical margins occurred in 1,862 patients (22%). There was an apparent improvement in surgical margin rates up to a plateau at 200 to 250 surgeries. Changes in margin rates once this plateau was reached were relatively minimal relative to the CIs. The absolute risk difference for 10 vs 250 prior surgeries was 4.8% (95% CI 1.5, 8.5). Neither surgeon generation nor prior open radical prostatectomy experience was statistically significant when added to the model. The rate of decrease in positive surgical margins was more rapid in the open vs laparoscopic learning curve. CONCLUSIONS: The learning curve for surgical margins after laparoscopic radical prostatectomy plateaus at approximately 200 to 250 cases. Prior open experience and surgeon generation do not improve the margin rate, suggesting that the rate is primarily a function of specifically laparoscopic training and experience. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/20952022/The_learning_curve_for_laparoscopic_radical_prostatectomy:_an_international_multicenter_study_ DB - PRIME DP - Unbound Medicine ER -