Open Access Research article

Approach to endoscopic extraperitoneal radical prostatectomy (EERPE): the impact of previous laparoscopic experience on the learning curve

Andreas Blana1, Markus Straub1, Peter J Wild2, Jens C Lunz1, Thorsten Bach3, Wolf F Wieland1 and Roman Ganzer1*

Author Affiliations

1 Department of Urology, University of Regensburg, St Josef's Hospital, Landshuter Strasse 65, 93053 Regensburg, Germany

2 Department of Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland

3 Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany

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BMC Urology 2007, 7:11  doi:10.1186/1471-2490-7-11

Published: 9 July 2007

Abstract

Background

We report our approach regarding the technique of endoscopic extraperitoneal radical prostatectomy (EERPE) and analyze the learning curve of two surgeons after thorough technical training under expert monitoring. The purpose of this study was to investigate the influence of expert monitoring on the surgical outcome and whether previous laparoscopic experience influences the surgeon's learning curve.

Methods

EERPE was performed on 120 consecutive patients by two surgeons with different experience in laparoscopy. An analysis and comparison of their learning curve was made.

Results

Median operation time: 200 (110 – 415) minutes. Complications: no conversion, blood transfusion (1.7%), rectal injury (3.3%). Median catheterisation time: 6 (5 – 45) days. Histopathological data: 55% pT2, 45% pT3 with a positive surgical margin rate of 6.1% and 46%, respectively. After 12 months, 78% of the patients were continent, 22% used 1 or more pad. Potency rate with or without PDE-5-inhibitors was 66% with bilateral and 31% with unilateral nerve-sparing, respectively. Operation time was the only parameter to differ significantly between the two surgeons.

Conclusion

EERPE can be learned within a short teaching phase. Previous laparoscopic experience is reflected by shorter operation times, not by lower complication rates or superior early oncological data.