Impact of Learning Curve in Laparoscopic Radical Prostatectomy on Margin Status: Prospective Study of First 100 Procedures Performed by One Surgeon

Abstract

Purpose: To describe the experience of a single surgeon with his first 100 laparoscopic radical prostatectomies and determine the impact of the learning curve on the surgical margin status according to the rate of nervesparing procedures. Patients and Methods: Between December 2000 and April 2002, 100 laparoscopic radical prostatectomies were performed by one surgeon without any selection of patients and without the help of any other surgeon. The procedures were divided in four groups of 25 consecutive cases. There was no significant difference among the groups in terms of age, clinical and pathological stage, or Gleason score. Nerve-sparing (NS) dissection was performed when the procedure was easy. Positive surgical margins (SM+) were measured and classified according to their location. Results: The overall rate of SM+ was 12.8% in pT2 and 31.8% in pT3 tumors. The SM+ rate was not significantly different among the groups. In contrast, the number of NS dissections (49 patients) increased from group 1 to group 4. Both the postive margin length and the rate of multiple positive margins were significantly lower in the 50 most recent patients. Conclusion: Nerve-sparing surgery was performed with increasing frequency during this learning curve without compromising the surgical margins. The results suggest that experience could lead to a decrease of both the positive margin length and the rate of multiple positive margins. The impact on cancer control and potency is under evaluation.