Laparoscopic radical prostatectomy: reducing the learning curve

To review the operative results of a single surgeon after a laparoscopic radical prostatectomy (LRP) fellowship to assess whether the LRP learning curve can be abbreviated.

We undertook a prospective study of 50 men who underwent LRP performed by a recently graduated LRP fellowship-trained surgeon. The patient details, operative data, complications, and post-operative followup were collected over the initial 12-month period.

The median age was 63 years (range, 47 to 72 years) and median follow-up of 6 months (range, 1 to 12 months). The majority of patients had a preoperative clinical stage T1c (30 = 60%) with a median PSA of 6.4 ng/mL. The median operative time was 225 minutes (range, 160 to 360 minutes) and median blood loss was 400 mL. There were three major complications: 1 anastamotic revision and 2 bladder neck contractures. The positive surgical margin rate for pT2 disease was 5% and for pT3 disease was 20%. Continence rates were 87% at 12 months (no pad use); unilateral (14%) and bilateral nerve sparing (34%) yielded early return of potency in 37.5% of men. No conversions, no rectal injuries, and no deaths occurred in the series.

The learning curve that has been observed in other series is not seen with regard to operative time or complication rates. Crucially, it is not seen in a positive surgical margin rate. A dedicated fellowship in laparoscopic radical prostatectomy abbreviates the extensive learning curve for this most technically challenging procedure.