The Australian laparoscopic radical prostatectomy learning curve

Abstract

Background International estimates of the laparoscopic radical prostatectomy (LRP) learning curve extend to as many as 1000 cases, but is unknown for Fellowship‐trained Australian surgeons. Methods Prospectively collected data from nine Australian surgeons who performed 2943 consecutive LRP cases was retrospectively reviewed. Their combined initial 100 cases (F100, n = 900) were compared to their second 100 cases (S100, n = 782) with two of nine surgeons completing fewer than 200 cases. Results The mean age (61.1 versus 61.1 years) and prostate specific antigen (7.4 versus 7.8 ng/mL) were similar between F100 and S100. D'Amico's high‐, intermediate‐ and low‐risk cases were 15, 59 and 26% for the F100 versus 20, 59 and 21% for the S100, respectively. Blood transfusions (2.4 versus 0.8%), mean blood loss (413 versus 378 mL), mean operating time (193 versus 163 min) and length of stay (2.7 versus 2.4 days) were all lower in the S100. Histopathology was organ confined (pT2) in 76% of F100 and 71% of S100. Positive surgical margin (PSM) rate was 18.4% in F100 versus 17.5% in the S100 (P = 0.62). F100 and S100 PSM rates by pathological stage were similar with pT2 PSM 12.2 versus 9.5% (P = 0.13), pT3a PSM 34.8 versus 40.5% (P = 0.29) and pT3b PSM 52.9 versus 36.4% (P = 0.14). Conclusion There was no significant improvement in PSM rate between F100 and S100 cases. Perioperative outcomes were acceptable in F100 and further improved with experience in S100. Mentoring can minimize the LRP learning curve, and it remains a valid minimally invasive surgical treatment for prostate cancer in Australia even in early practice.

The learning curves of major laparoscopic and robotic procedures in urology: A systematic review

“…Sixteen studies 37 , 54 , 61 – 74 analysed the learning curve of LRP. Handmer et al 66 retrospectively reviewed data from nine Australian surgeons, reporting lower rates of mean blood loss (413 vs. 378 ml), blood transfusions (2.4 vs. 0.8%) and decreased length of stay (2.7 vs. 2.4 days) in the surgeons’ first 100 combined cases compared to the second 100. Di Gioia et al 62 , examining the first 240 LRPs performed by a surgeon with open and laparoscopic experience, reported a significant decrease in the mean anastomosis time ( P <0.001) as case number increased, concluding that up to 80 cases were required to achieve a plateau in time-related outcomes.…”