Impact of learning curve on perioperative complications in laparoscopic radical prostatectomy: a single center experience of 200 consecutive cases

Abstract

Objective To assess the impact of learning curve on perioperative complications in laparoscopic radical prostatectomy (LRP) by a series of consecutive 200 cases in a single center. Methods Two hundred patients who were biopsy proved prostatic carcinoma and underwent LRP were retrospectively evaluated.All the operations were performed by professor Ma Lulin.The patients were divided into 4 groups according the time of operation.All the clinical data, including age, body mass index (BMI), preoperative PSA level, biopsy Gleason score, and clinical stage were collected.Operative parameters and peri–operative complications were evaluated, including operative time, blood loss, transfusion rate, and perioperative complications.The complications were evaluated by Clavien classification system. Results Age, BMI, PSA, prostate volume, biopsy Gleason score and clinical stage had no significant difference among the 4 groups (P>0.05). The operative time was gradually lowered from group one to group four.Significantly less blood loss occurred after every 50 cases of LRP (P<0.001). The complication rates were 15.5% in this series, 28.0%, 18.0%, 12.0% and 4.0% for group one to group four respectively.The complication rate reduced as experience was gained(P=0.008). The rates of mild complications were 24.0%, 14.0%, 6.0% and 4.0%, and severe complication rates were 4.0%, 4.0%, 6.0% and 0, respectively. Conclusion With experience was gained and technique was improved, the operative time and blood loss of LRP decreased and complication rate reduced substantially. Key words: Prostatic neoplasms; Learning curve; Prostatectomy; Laparoscopes; Complications