BACKGROUND: Laparoscopic radical prostatectomy (LRP) represents an established treatment modality for localised prostate cancer. OBJECTIVE: To report standardised complication rates for LRP, evaluate the development of complication rates over time, and show changes within the learning curves of laparoscopic surgeons. DESIGN, SETTING, AND PARTICIPANTS: We conducted a standardised analysis of 2200 consecutive patients who underwent LRP between 1999 and 2008 at a single institution. INTERVENTION: LRP was performed using a transperitoneal (n=871) or extraperitoneal (n=1329) retrograde Heilbronn technique. Five surgeons operated on 96% of the patients. MEASUREMENTS: Complications were classified according to the modified Clavien system. Total complication rates and changes over time were analysed. Three generations of surgeons were defined for evaluation of learning curves. RESULTS AND LIMITATIONS: Minor complications occurred in 21.7% of patients (Clavien 1: 6.8%; Clavien 2: 14.9%); anaemia requiring transfusion (10.4%) dominated. Early reinterventions were necessary in 6.7% of patients (Clavien 3a: 3.6%; Clavien 3b: 1.5%; Clavien 4a: 1.5%; Clavien 4b: 0.1%). Late Clavien 3b complications occurred in 4.7% of patients-most of them anastomotic strictures. Mortality was 0.1% (Clavien 5). There was a significant decrease in overall complication rates over time, resulting predominantly from decreasing Clavien 1-2 events. Learning curves of third-generation surgeons plateaued earlier compared to the first generation (250 vs 700 cases). The limitation of this study is that data concerning comorbidity were not included. CONCLUSIONS: LRP is a safe procedure characterised by an acceptable profile of complications. Specifically, few major complications are reported. According to the complication rates, the learning curve of third-generation surgeons is significantly shorter compared to first- and second-generation surgeons.
BACKGROUND: Laparoscopic radical prostatectomy (LRP) represents an established treatment modality for localised prostate cancer. OBJECTIVE: To report standardised complication rates for LRP, evaluate the development of complication rates over time, and show changes within the learning curves of laparoscopic surgeons. DESIGN, SETTING, AND PARTICIPANTS: We conducted a standardised analysis of 2200 consecutive patients who underwent LRP between 1999 and 2008 at a single institution. INTERVENTION: LRP was performed using a transperitoneal (n=871) or extraperitoneal (n=1329) retrograde Heilbronn technique. Five surgeons operated on 96% of the patients. MEASUREMENTS: Complications were classified according to the modified Clavien system. Total complication rates and changes over time were analysed. Three generations of surgeons were defined for evaluation of learning curves. RESULTS AND LIMITATIONS: Minor complications occurred in 21.7% of patients (Clavien 1: 6.8%; Clavien 2: 14.9%); anaemia requiring transfusion (10.4%) dominated. Early reinterventions were necessary in 6.7% of patients (Clavien 3a: 3.6%; Clavien 3b: 1.5%; Clavien 4a: 1.5%; Clavien 4b: 0.1%). Late Clavien 3b complications occurred in 4.7% of patients-most of them anastomotic strictures. Mortality was 0.1% (Clavien 5). There was a significant decrease in overall complication rates over time, resulting predominantly from decreasing Clavien 1-2 events. Learning curves of third-generation surgeons plateaued earlier compared to the first generation (250 vs 700 cases). The limitation of this study is that data concerning comorbidity were not included. CONCLUSIONS: LRP is a safe procedure characterised by an acceptable profile of complications. Specifically, few major complications are reported. According to the complication rates, the learning curve of third-generation surgeons is significantly shorter compared to first- and second-generation surgeons.
Authors: Florian Imkamp; Thomas R W Herrmann; Jens U Stolzenburg; Jens Rassweiler; Tullio Sulser; Uwe Zimmermann; Sebastian Dziuba; Markus A Kuczyk; Martin Burchardt Journal: World J Urol Date: 2014-02-04 Impact factor: 4.226
Authors: Björn Löppenberg; Christian von Bodman; Marko Brock; Florian Roghmann; Joachim Noldus; Rein Jüri Palisaar Journal: Qual Life Res Date: 2014-06-06 Impact factor: 4.147
Authors: A I Tasci; I Tufek; E Gumus; A E Canda; V Tugcu; F Atug; U Boylu; Z Akbulut; S Sahin; A Simsek; A R Kural Journal: World J Urol Date: 2014-09-13 Impact factor: 4.226
Authors: Hakan Akdere; Tevfik Aktoz; Mehmet Gürkan Arıkan; İrfan Hüseyin Atakan; Domenico Veneziano; Ali Serdar Gözen Journal: Turk J Urol Date: 2019-10-21
Authors: Anuar I Mitre; Mario F Chammas; José Eugênio A Rocha; Ricardo Jordão Duarte; Gustavo Xavier Ebaid; Flavio Trigo Rocha Journal: ScientificWorldJournal Date: 2013-03-03