Defining a learning curve for laparoscopic simple prostatectomy: learning curve for laparoscopic Millin

Flavio Lobo Heldwein; Eric Barret; Rafael Sanchez-Salas; Marc Galiano; Xavier Cathelineau; Guy Vallancien

doi:10.55825/recet.sbu.0144

Autores

Flavio Lobo Heldwein Universidade Federal de Santa Catarina (UFSC), Florianopolis/SC, Brazil
Eric Barret Department of urology, Institut Mutualist Montsouris, Paris - France
Rafael Sanchez-Salas Department of Urology, Institut Mutualist Montsouris, Paris - frança
Marc Galiano Department of Urology, IMM
Xavier Cathelineau IMM
Guy Vallancien IMM

DOI:

https://doi.org/10.55825/recet.sbu.0144

Palavras-chave:

Benign prostatic hyperplasia, adenomectomy, laparoscopic, learning curve

Resumo

Introdução: Determinar o número de procedimentos para alcançar competência na prostatectomia simples laparoscópica (LSP).

Métodos: 101 pacientes consecutivos com hiperplasia prostática benigna sintomática foram submetidos à LSP entre janeiro de 2003 e janeiro de 2008. Volume da próstata, IPSS, urofluxometria, residual pós vazio, tempo médio operatório, perda de sangue estimada, duração do uso do cateter, tempo de internação e taxas de complicações foram analisados neste subconjunto de pacientes, dividindo os pacientes em um dos seis grupos: Grupo I, casos 1-5; Grupo II, casos 6-10; Grupo III, casos 11-15; Grupo IV, casos 16-25; Grupo V, casos 26-40; Grupo VI, casos >40.

Resultados: Não houve diferença entre os grupos em termos de idade, volume de próstata, urofluxometria, ou resíduo pós-miccional. As pontuações IPSS foram significativamente diferentes entre os grupos (p = 0,013). Houve uma diminuição significativa no tempo cirúrgico médio entre o Grupo I (115 minutos) comparado ao Grupo VI (60 minutos) (p<0,001).

Conclusão: A prostatectomia simples laparoscópica é segura com resultados comparáveis às séries de prostatectomia aberta. O tempo operatório pode ser reduzido com a prática, e estimamos que a curva de aprendizado para este procedimento seja de 25 casos.

ABSTRACT

Introduction: Achieving competency in laparoscopic simple prostatectomy (LSP) requires a thorough understanding of the learning curve associated with this minimally invasive procedure. In this study, we aimed to identify the point at which competency is achieved in LSP by analyzing outcomes from our first 101 LSP cases.

Methods: A total of 101 consecutive patients with symptomatic benign prostatic hyperplasia underwent LSP between January 2003 and January 2008. We analyzed prostate volume, International Prostate Symptom Score (IPSS), uroflowmetry, post void residual, mean operative time, estimated blood loss, duration of catheter use, length of hospital stay, and complication rates in this patient subset. The patients were divided into six groups based on the number of cases performed: Group I (cases 1-5), Group II (cases 6-10), Group III (cases 11-15), Group IV (cases 16-25), Group V (cases 26-40), and Group VI (cases >40).

Results: No significant differences were observed between the groups in terms of age, prostate volume, uroflow, or post void residual. However, IPSS scores were significantly different between the groups (p = 0.013). Mean operative time decreased significantly between Group I (115 minutes) versus Group VI (60 minutes) (p < 0.001).

Conclusion: Our study findings demonstrate that laparoscopic simple prostatectomy is a safe procedure with comparable outcomes to open prostatectomy series. The results suggest that the learning curve for this procedure can be achieved with practice, and we estimate that it requires 25 cases to reach competency. These findings can be useful in optimizing training of urologists in LSP.

KEY-WORDS:

Benign prostatic hyperplasia, adenomectomy, laparoscopic, learning curve

Recebido em: 03/04/2023
Aprovado em: 30/07/2023

Biografia do Autor

Flavio Lobo Heldwein, Universidade Federal de Santa Catarina (UFSC), Florianopolis/SC, Brazil

ORCID: 0000-0003-4321-0078 http://lattes.cnpq.br/9139471702589324

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