Learning Curve of Laparoscopic Radical Prostatectomy in a University Teaching Hospital: Experience after the First 600 Cases

Martínez‐Piñeiro, Luis; Cáceres, F.; Sánchez, Carlos; Tabernero, A.; Cansino, José R.; Alonso, Sergio; Cisneros, Jesús; Peña, J.J. de la

doi:10.1016/j.eursup.2006.07.018

Cited by 20 publications

(21 citation statements)

References 21 publications

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“…[12][13][14][15]19,[21][22][23][24][25][26][27] In general, the +SM increased with the pathological stage, with ranges from 0% 23 16,20,28 reported +SM by T stage, but as it was unclear as to whether these were clinical or pathological stage, these data are not included here.…”

Section: Pathological Stage and +Smmentioning

confidence: 99%

“…14,24,[26][27][28]30,32,33 This topic is discussed further in the section below under Question 3 related to nerve sparing surgery.…”

Section: Surgical Technique and +Smmentioning

confidence: 99%

“…13 A second laparoscopic study found 40.3% of +SM were posterolateral, 26.1% were apical, 6.2% were anterior and 6.2% were at the bladder neck. 24 …”

Section: Margin Site and +Sm Ratesmentioning

confidence: 99%

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Guideline for optimization of surgical and pathological quality performance for radical prostatectomy in prostate cancer management: evidentiary base

Chin

Srigley

Mayhew

et al. 2013

CUAJ

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Background: The objective is to provide surgical and pathological guidelines for radical prostatectomy (RP) with or without concurrent pelvic lymph node dissection (PLND) to achieve optimal benefit for patients, with minimal risk of harm. Methods:For surgical questions, a literature search of MEDLINE, EMBASE and the Cochrane database was performed. A literature search for the pathological questions was not conducted since the protocol for invasive carcinomas of the prostate gland developed by the College of American Pathologists (CAP) was endorsed. Urologists and pathologists were consulted for their assessment of the surgical and pathological recommendations. Results:Limited high-quality evidence from 95 primary studies was available and, therefore, the expert panel developed recommendations on the basis of a consensus of the expert opinion of the working group and through a consultation with urologists and pathologists. In addition to the CAP protocol, some technical recommendations related to the handling and processing of the specimen were made. Conclusion:Radical prostatectomy is recommended for the surgical treatment of prostate cancer, depending on a patient's preoperative risk profile. The panel unanimously determined that the goals for RP are to attain a positive margin rate of <25% for pT2 disease, a mortality rate of <1%, rates of rectal injury of <1% and blood transfusion rates of <10% in non-anemic patients. Standard PLND should be mandatory in high-risk patients, should be recommended for intermediate-risk patients and should be optional for low-risk patients. The quality and effectiveness of this treatment and of subsequent patient care depend on good management, effective communication and reporting between surgeons and pathologists working together as part of a multidisciplinary

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Section: Pathological Stage and +Smmentioning

confidence: 99%

“…14,24,[26][27][28]30,32,33 This topic is discussed further in the section below under Question 3 related to nerve sparing surgery.…”

Section: Surgical Technique and +Smmentioning

confidence: 99%

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Guideline for optimization of surgical and pathological quality performance for radical prostatectomy in prostate cancer management: evidentiary base

Chin

Srigley

Mayhew

et al. 2013

CUAJ

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“…The educational gap between the present well-designed fellowship program and mini-sabbaticals 19 can be decreased not only by the number of surgeries during/after the training program, but also the video re-assessment of the surgical steps combined with pathological re-evaluation of the surgical margin positive slides. 23 In addition, synchronous working of the surgical team and real-time 'off the operation room' (tele-)mentor guidance are other advantageous modalities in which laparoscopic dissection can be recommended during the operation.…”

Section: In-door Versus Out-door Groupmentioning

confidence: 99%

“…19 However, the number of cases needed to reach proficiency varies from 50 to 60 for LRP. 5,20 Unfortunately, there is a lack of objective measures to assess technical competence.…”

Section: Limitations Of Existing Training Programsmentioning

confidence: 99%

Laparoscopic radical prostatectomy: Transfer validity

et al. 2010

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Objectives:The impact of a formal fellowship training program on the independent practice of the trainees (i.e. transfer validity) has not been evaluated. We analyzed the transfer validity of a structured curriculum in an in-door as well as an out-door setting. Methods: After completing their training, two fourth generation laparoscopic surgeons who started at the same time compared operative parameters and oncological outcomes in their independent practice, prospectively analyzing the next 100 patients in each. One surgeon continued laparoscopic radical prostatectomy (LRP) in the same center of excellence (Group-In), whereas the other implemented the procedure in a separate academic center (Group-Out). Results: The demographics for both groups (Group-In vs Group-Out) were similar regarding age, prostate volume and preoperative prostate-specific antigen levels. Mean operation times (214.8 vs 224.2 min; P = 0.494) and estimated blood loss (472.4 vs 402.6 mL; P = 0.109) did not differ significantly in both groups as well as complication rate (20 vs 24%), median catheter time (8 vs 8.5 days) and continence rates at 12 months (95 vs 95.5%). According to the pathological stages, the rates of positive surgical margins were similar for pT2 (3.2 vs 4.3%) and pT3 (42.8 vs 45.2%), respectively. Conclusions: With a well designed , long-term preclinical and clinical fellowship training program, LRP techniques can be efficiently transferred from the center of excellence to other centers with no significant impact on surgical, functional and oncological outcomes.

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