Laparoscopic radical prostatectomy: introduction of training during our first 50 cases

Abstract

The study aims to assess the initial experience of laparoscopic radical prostatectomy (LRP) in a regional centre in Australia which includes Fellowship training during our first 50 cases. Data were collected prospectively from our first 50 consecutive patients who underwent LRP for localized prostate cancer between September 2009 and October 2010. All cases were performed or supervised by the primary surgeon. Patient details, operative details, complications, early oncological and functional outcomes were analysed. The median age was 65 (45-76) years and median preoperative prostate-specific antigen was 7.5 (2.5-23) ng/mL, with palpable disease present in 48%. Using D'Amico's risk stratification, 14%, 74% and 12% were in low, intermediate and high-risk categories, respectively. Forty percent of cases were training cases with a median of 5 (2-8) of 10 operative steps performed by the Fellow. There was one open conversion and no rectal injuries. Mean operative time was 288 (175-440) min and with blood transfusion rate of 6%. Mean length of stay was 2.5 (1-6) days. Positive surgical margin rates for pT2 and pT3 disease were 14% and 52%, respectively, although for the last 25 cases they were 7% and 30%, respectively. Continence rate was 86% at 6 months, and 45% and 33% of preoperatively potent patients were potent after bilateral and unilateral nerve preservation at 6 months. LRP has been safely introduced in a regional centre with establishment of a Fellowship training programme, with early results comparable with other open, laparoscopic and robotic series.