TY - JOUR
T1 - Laparoscopic radical prostatectomy
T2 - Six months of fellowship training doesn't prevent the learning curve when incorporating into a lower volume practice
AU - Brown, James A.
AU - Sajadi, Kamran P.
N1 - Funding Information:
A urologist (JAB) in his fifth year of practice at our medical center coordinated and performed postresidency laparoscopic urologic surgical training with the support of the Medical College of Georgia's general surgery department and urology division. This series of four 3-month mini-fellowships was performed over 30 months from January 2002 to July 2004 with grant funding support from the Georgia Cancer Coalition [2] . The first (Thomas Jefferson University, Philadelphia, January–April 2002) and the third (Massachusetts General Hospital, Boston, April–July 2003) included high volume (≥4 cases per month) training in LRP surgery. The LRP training included 29 transperitoneal (TP) and 23 extraperitoneal (EP) procedures. The trainee performed part of 26 and all of the last 2 cases. The last 2 cases were performed in approximately 3 hours skin–skin operative time by the trainee with the assistance of his mentoring expert LRP surgeon. Additionally, the trainee performed approximately 30 minutes of laparoscopic suturing practice on a box trainer several times each week during the first 3-month mini-fellowship.
PY - 2009/3
Y1 - 2009/3
N2 - Introduction: To assess whether 6 months of standard laparoscopic radical prostatectomy (LRP) training reduces the learning curve. Methods: A single urologist (JAB) performed two 3-month fellowships at medical centers with high-volume LRP surgeons (Thomas Jefferson University, 2002 and Massachusetts General Hospital, 2003). He participated in 29 transperitoneal and 23 extraperitoneal LRPs, performing part or all (2) of 28 cases. He subsequently initiated a LRP program at our institution in July 2003, performing 32 procedures between July 2003 and June 2006 (excluding a 3-month 2004 robotic surgery sabbatical). Six residents served as assistant. Results: Median patient age, BMI, and preoperative PSA were 58 (46-71) years, 30 (21-37), and 5.4 (3.2-13.6) ng/ml, respectively. Median estimated blood loss (EBL) and operative time were 400 (50-1700) ml and 411 (282-652) minutes. Median hospital stay, catheterization, and follow-up were 2 (1-12) days, 15 (8-52) days, and 10 (1-30) months, respectively. Ten (31%) and 6 (19%) underwent pelvic lymphadenectomy and open conversion. Five patients (16%) received transfusion. Twenty-three (72%) were pathologic stage pT2 and 9 (28%) pT3. Thirteen, 15, and 3 specimens were Gleason 6, 7, and ≥8, respectively. Fifteen (47%) had positive surgical margins (14 apical and 7 other sites). Nineteen (59%) had complications and 4 (12.5%) salvage radiation therapy. Of 20 patients followed 12 months, 12 (60%) are continent (pad free) and 4 (27%) potent patients remain so with or without PDE5 inhibitor. Conclusion: Six months of training (52 cases, 28 as surgeon for part or all) did not alleviate the LRP learning curve.
AB - Introduction: To assess whether 6 months of standard laparoscopic radical prostatectomy (LRP) training reduces the learning curve. Methods: A single urologist (JAB) performed two 3-month fellowships at medical centers with high-volume LRP surgeons (Thomas Jefferson University, 2002 and Massachusetts General Hospital, 2003). He participated in 29 transperitoneal and 23 extraperitoneal LRPs, performing part or all (2) of 28 cases. He subsequently initiated a LRP program at our institution in July 2003, performing 32 procedures between July 2003 and June 2006 (excluding a 3-month 2004 robotic surgery sabbatical). Six residents served as assistant. Results: Median patient age, BMI, and preoperative PSA were 58 (46-71) years, 30 (21-37), and 5.4 (3.2-13.6) ng/ml, respectively. Median estimated blood loss (EBL) and operative time were 400 (50-1700) ml and 411 (282-652) minutes. Median hospital stay, catheterization, and follow-up were 2 (1-12) days, 15 (8-52) days, and 10 (1-30) months, respectively. Ten (31%) and 6 (19%) underwent pelvic lymphadenectomy and open conversion. Five patients (16%) received transfusion. Twenty-three (72%) were pathologic stage pT2 and 9 (28%) pT3. Thirteen, 15, and 3 specimens were Gleason 6, 7, and ≥8, respectively. Fifteen (47%) had positive surgical margins (14 apical and 7 other sites). Nineteen (59%) had complications and 4 (12.5%) salvage radiation therapy. Of 20 patients followed 12 months, 12 (60%) are continent (pad free) and 4 (27%) potent patients remain so with or without PDE5 inhibitor. Conclusion: Six months of training (52 cases, 28 as surgeon for part or all) did not alleviate the LRP learning curve.
KW - Laparoscopic prostatectomy
KW - Learning curve
KW - Outcomes
KW - Practice volume
KW - Radical prostatectomy
KW - Surgeon volume
KW - Surgical volume
KW - Training
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U2 - 10.1016/j.urolonc.2007.11.030
DO - 10.1016/j.urolonc.2007.11.030
M3 - Article
C2 - 18367119
AN - SCOPUS:61649102675
SN - 1078-1439
VL - 27
SP - 144
EP - 148
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 2
ER -