A safe teaching protocol of LRP (Laparoscopic Radical Prostatectomy)

Abstract

PurposeThe LRP has a steep learning curve to obtain proficiency during which patient safety may be compromised. We present an adapted modular training system which purpose to optimize the learning curve and perform a safe surgery.Materials and MethodsA retrospective analysis of the LRP safe learning protocol applied during a fellowship program over eight years (2008-2015).The surgery was divided in 12 steps and 5 levels of difficulty. A maximum time interval was stipulated in 240 minutes. After an adaptation, the fellows had 120 minutes to perform all the corresponding modules to its accumulated skill. The participants gradually and safely pass through the steps and difficulty levels. Surgeries performed by fellows were analyzed as a single group and compared to a prior series performed by tutor.ResultsIn eight years, 250 LRP were performed (25 per apprentice) during fellowship program and 150 procedures after completion. The baseline characteristics were comparable. Most cases operated were of intermediate risk. Mean operative time was longer in the fellow group when compared to the tutor (150 min). Mean estimated blood loss were similar among the groups. Functional and oncological outcomes were better in the Tutor's group. No conversion to open surgery was performed.ConclusionsThe LRP safe learning protocol proved to be an effective method to optimize the learning curve and perform safe surgery. However, the tutor's functional and oncological results were better, showing that this is a procedure with a steep learning curve and proficiency demands more than 25 cases.

Beforehand transection and suturing (BTS) of the dorsal vascular complex: a novel technique in laparoscopic radical prostatectomy

“…Mixter forceps were passed posterior to the DVC, which was transected with a 15-blade knife. The DVC was ligated upfront in a RP and subsequently transected before dissection of the prostate (5,10), but in laparoscopic surgery the majority of procedures follow ligation of the DVC, resection of the prostate except the apex, transection with or without reconstruction of the bladder neck of the DVC, separation of the apex, and division of the urethra (4).…”

“…The pre-prostate fat was dissected during an eLRP and sent for pathologic evaluation. After excision of the pre-prostatic fat (5) and incision of the pelvic fascia, the pubovesical ligament and DVC were exposed. The preference, but not requirement, was to continue the dissection as close as possible to the DVC-urethral space or the point that the DVC, urethra, and prostate connect.…”

Laparoscopic Radical Prostatectomy: Single Center Case Series

“…Step-wise teaching protocols and formal training, as described in Brazil 29 and Australia 15 , can be used to optimize and abbreviate the learning curve and effectively teach safe and successful LRP with regard to oncology. Along with the growth of the capacity of surgical technique, the perioperative outcomes are upgrading and the hospital stay getting shorter.…”

Endoscopic Extraperitoneal Transvesicocapsular Adenomectomy of Prostate (EETAP): A New Operative Method with an Innovative Learning Protocol for Its Performance

“…This protocol compares the EERPE surgical procedure to our adenomectomy surgical technique, EETAP. Moreover, training protocols for endoscopic extraperitoneal radical prostatectomy are found in the literature that can serve to build operator skills as a basis for our method [37][38][39]. According to the learning protocol of Stolzenburg JU, even residents without open surgery skills can perform EERPE after learning this protocol [40].…”