Temporal relationship between positive margin rate after laparoscopic radical prostatectomy and surgical 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.