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

ObjectivesTo review features of initial and subsequent learning curves of laparoscopic radical prostatectomy (LRP).MethodsA total of 604 patients underwent LRP. Two surgeons started the programme. After the completion of the first 103 cases, three generations of surgeons entered the programme stepwise. Thirty-four patients were operated by four different surgeons, with limited laparoscopic experience, and were considered as a single, separate group for analysis. Patient data, operating data, intraoperative and postoperative complications, and positive surgical margins were analysed chronologically for the whole group and for each surgeon.ResultsMean operating time (201.5 ± 68.0 min), estimated blood loss (346.7 ± 351.7 ml), transfusion rate (11.3%), and intraoperative complications diminished with surgical experience and were less in the newer generations of surgeons (p < 0.001). However, postoperative complications, prolonged hospital stay, and late removal of the drainage tube occurred significantly more frequently in surgeons who just performed LRP procedures occasionally. Postoperative pain decreased significantly with increasing surgical experience (p < 0.05), but mean hospital stay (3.5 d) did not change in the whole series. Positive margin rate varied greatly among surgeons (overall positive margin rates pT2 = 19.2%, pT3 = 53.2%). There was a trend towards reduction of positive surgical margins in pT2 cases in most surgeons as experience grew. The combined retrograde-descending technique was associated with higher rates of positive margins at the apex (11.4% combined technique vs. 6.7% descending technique), whereas positive margins at the posterolateral region were more frequent in the descending technique (9% combined technique vs. 12.5% descending technique).ConclusionsExperience gained by the first generation of surgeons helped newer surgeons reduce the duration and morbidity of their corresponding learning curves.