Teaching And Mentoring: A Multi-Center Laparoscopic Radical Prostatectomy Experience

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 06 Jul 2008 - 1:00 PDT

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ORLANDO, FL (UroToday.com) - Canadian investigators created a teaching and mentoring method called "block" surgery to simplify and improve time efficiency and safety while maintaining acceptable oncological and functional outcomes during the learning curve of a laparoscopic radical prostatectomy (LRP).

The LRP was broken down into 10 key "blocks" assigned different levels of difficulty. Practicing urologists were recruited from multiple centers. They compared the clinical outcomes when trainees did less than 50% of the case (group I), more than 50% of the case (group II), 100% of the case (group III) and when the mentor did the case alone (group IV).

They compared operative demographic data, peri-operative data, and post-operative oncological and functional data. Erectile incontinence data were captured using the IIEF and UCLA Prostate Cancer Index (UCLA PCI). Prior to the study, all those being mentored had at least 100 laparoscopic cases completed. A total of 8 urologists were mentored from 4 academic and 2 private centers. A total of 303 cases were completed (Grp I-34 cases, Grp II-27 cases, Grp III-55 cases, Grp IV-187 cases). There were no significant demographic differences between the 4 groups including the median blood loss, mean morphine use post-operatively, length of stay, conversion rate, complications, stage, positive margins and PSA level after 6 months. A difference was noted in the mean operative time (I-215, II-235, III-210, IV-178 minutes, p<0.05). At six months, group III had a higher incontinence rate (via UCLA PCI score). Decline in erectile functions (IIEF) were similar in all 4 groups. The median number of mentored cases needed to perform LRP independently for this highly select group of urologists was 8.

This is a unique report of the first multicenter LRP mentoring experience. These educators suggest that a mentoring program utilizing faculty with extensive laparoscopic experience can diminish the learning curve and allow safe implementation of a LRP program with acceptable oncological and functional outcomes. Further studies with larger numbers of trainees will be necessary.

Presented by Jamie Wong, MD, et al., at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Aldrin Joseph R. Gamboa, MD

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