Comparison of training modalities for performing laparoscopic radical prostatectomy: Experience with 1,000 patients

Purpose: We report a detailed analysis of different training modalities on the transferability of laparoscopic radical prostatectomy to generations of surgeons. Material and Methods: The first generation surgeon with experience with 600 cases and the second generation surgeon with 150 were trained in open retropubic radical prostatectomy and laparoscopy, whereas the third generation surgeon with 150 cases was trained only laparoscopically. The fourth generation of surgeons with a total of 50 cases was trained in our fellowship program. We analyzed groups of 50 operations. The groups were comparable with respect to patient age, prostate weight and pathological tumor stage. Results: We observed a continual decrease in operative time between (322 to 247 minutes.) and within (332 to 196 minutes.) the analyzed groups. This result was also expressed in a decrease in the time required for anastomosis. A significant decrease was observed for the initial transfusion rate (4% to 10%). No difference was found in the complication rate (ie conversion in 8% to 0% of cases). Pathological outcomes (ie positive margins for pT2/pT3) were comparable in the first 3 surgeon groups (14.9%, 14.2% and 22%, respectively) and available functional results (followup greater than 2 years) did not reveal any influence of the learning curve. A learning curve was observed only for overall operative time and the time required for anastomosis but it was shown to be significantly shorter for the following generations. Conclusions: Based on a specific training program the personal level of education has a minor impact on the results and reproducibility of the laparoscopic radical prostatectomy technique.