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Updated: Jun 6, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Temporal relationship between positive margin rate after laparoscopic radical prostatectomy and surgical training
Jay B Page1, Daniel L Davenport, Raman Unnikrishnan
1Division of Urology, University of Kentucky, Lexington, KY, USA. jay.page@uky.edu
Objectives:
To evaluate the potential impact of the experience of the first assistant on the positive surgical margin rate (PSMR) after laparoscopic radical prostatectomy (LRP). The impact of training surgical residents and fellows on patient outcomes is difficult to quantify.
Methods:
A single-institution prospective database of 303 patients who underwent LRP between 2003 and 2008 was evaluated. The potential impact of the experience of the first assistant on the PSMR was evaluated by examining the relationship between the PSMR and the time of the academic year. Multivariable logistic regression analysis was used to adjust for patient age, Gleason's sum, tumor density, and pathologic stage.
Results:
Overall positive margin rate was 18.2%. Positive margin rate for July and August (14/45, 31.1%) was significantly higher than for the remaining 10 months (41/258, 15.9%) P = .015. The increased risk of positive margin in July/August remained significant after adjusting for age, Gleason's sum, tumor density, and pathologic stage (OR 2.65, 95% CI 1.21-5.79, P = .015)
Conclusions:
LRP performed with the first assistant in the first 2 months of the academic training year have a significantly higher PSMR.
Insights
The experience of the first surgical assistant significantly impacts positive surgical margin rates in laparoscopic radical prostatectomy. Higher rates were observed early in the academic year, indicating a need for careful supervision during resident training.
Area of Science:
- Urology
- Surgical Oncology
- Medical Education
Background:
- Assessing the impact of surgical training on patient outcomes is challenging.
- The experience level of the first assistant may influence surgical outcomes.
Purpose of the Study:
- To determine if the first assistant's experience affects the positive surgical margin rate (PSMR) in laparoscopic radical prostatectomy (LRP).
- To investigate the correlation between the academic training period and PSMR in LRP.
Main Methods:
- Prospective database analysis of 303 LRP patients (2003-2008).
- Evaluation of PSMR in relation to the time of the academic year.
- Multivariable logistic regression adjusted for patient age, Gleason's sum, tumor density, and pathologic stage.
Main Results:
- The overall PSMR was 18.2%.
- PSMR was significantly higher in July/August (31.1%) compared to the rest of the year (15.9%), P = .015.
- This increased risk persisted after adjusting for clinical and pathological factors (OR 2.65, P = .015).
Conclusions:
- Laparoscopic radical prostatectomy performed with a first assistant in the initial months of the academic year is associated with a higher PSMR.
- This suggests a potential learning curve effect for first assistants early in training programs.
- Enhanced supervision or support may be necessary during these periods to optimize patient outcomes.