Learning Curve of an Innovative “3-Port” Laparoscopic Radical Prostatectomy: A Single-Center Analysis from 2016 to 2019

Background: “Three-port” laparoscopic radical prostatectomy (LRP) has been applied as a substitution for the conventional 4- to 5-port LRP to treat prostate cancer (PCa) patients in our institution. Objective: To evaluate the learning curve of an innovative “3-port” LRP for PCa patients. Methods: 206 patients who received “3-port” LRP were retrospectively reviewed between January 2016 and December 2019 at our institution. According to the different years of operations performed, all of the patients were divided into group A (No. 1–50), group B (No. 51–107), group C (No. 108–160), and group D (No. 161–206). A learning curve was depicted by analyzing the parameters of operative time (OT), estimated blood loss (EBL), hospitalization, and drainage indwelling days. Results: All groups were comparable with regard to the preoperative characteristics (p > 0.05). The sloping learning curve for the surgeon showed that OT and EBL were strongly correlated with an accumulated experience when compared between group A and the other groups (p < 0.05), denoting that the surgical skill of the “3-port” LRP can be fully mastered after around 50 cases. Although no significant correlation with additional experience was observed in the hospitalization and drainage indwelling days among groups, a tendency towards less hospitalization and drainage indwelling days was still reflected. Conclusions: Our 4-year analysis based on a single-center experience exhibits that the innovative “3-port” LRP appears to be favorable with decreasing tendency in OT and EBL with experience accumulation. In view of its advantage of perioperative parameters with an evidently improved learning curve, it should be recommended in the clinical practice!

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A novel “Three-port” trocar placement technique for laparoscopic radical prostatectomy

10.21203/rs.3.rs-60964/v2 ◽

2020 ◽

Author(s):

Ben Xu ◽

Yi-ji Peng ◽

Guo-Zhong Ma ◽

Qian Zhang

Keyword(s):

Radical Prostatectomy ◽

Learning Curve ◽

Laparoscopic Radical Prostatectomy ◽

Trocar Placement ◽

Estimated Blood Loss ◽

Group A ◽

The Mean ◽

Group B ◽

Group D ◽

Placement Technique

Abstract Background: To introduce a novel “three-port” trocar placement technique for laparoscopic radical prostatectomy (LRP) in prostate cancer (PCa) patients.Methods: We retrospectively reviewed 300 patients with PCa who received surgical treatment between November 2010 and June 2015 at our institution. They were divided into group A: three-port LRP, group B: conventional four-five port LRP, group C: open RP (ORP) and group D: robotic-assisted RP (RARP). A learning curve was analyzed by dividing patients of group A into the early and late stages.Results: All groups were comparable with regard to the preoperative characteristics except for the relatively smaller prostate volume in group A. The three-port LRP operations were performed successfully with only 8 cases conversion to the conventional LRP. None of any severe complications or conversion to ORP occurred. In group A, the mean operative time (OT) duration was 113.8min, the mean estimated blood loss (EBL) was 94.2ml, the mean drainage days was 4.0d, the mean hospitalization was 5.1d, and 27.8% of the prostate specimen margins (PSM) were positive. The differences of OT, EBL, drainage days, hospitalization and transfusion in group A were statistically significant among the majority of the other groups (p<0.05). After undergoing the early stages of a learning curve analysis in three-port LRP, the EBL was obviously decreased.Conclusions: Three-port LRP is a novel technique that exhibits superior intraoperative advantages to the conventional LRP. Due to its less OT, EBL, drainage days, hospitalization and transfusion with a shorter learning curve, it should be recommended and popularized in the clinical practice!

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A Novel “Three-Port” Trocar Placement Technique for Laparoscopic Radical Prostatectomy

10.21203/rs.3.rs-64035/v1 ◽

2020 ◽

Author(s):

Ben Xu ◽

Hai-feng Song ◽

Cheng Luo ◽

Qian Zhang

Keyword(s):

Radical Prostatectomy ◽

Learning Curve ◽

Laparoscopic Radical Prostatectomy ◽

Trocar Placement ◽

Estimated Blood Loss ◽

Group A ◽

The Mean ◽

Group B ◽

Group D ◽

Placement Technique

Abstract Background: To introduce a novel “three-port” trocar placement technique for laparoscopic radical prostatectomy (LRP) in prostate cancer (PCa) patients.Methods: We retrospectively reviewed 300 patients with PCa who received surgical treatment between November 2010 and June 2015 at our institution. They were divided into group A: three-port LRP, group B: conventional four-five port LRP, group C: open RP (ORP) and group D: robotic-assisted RP (RARP). A learning curve was analyzed by dividing patients of group A into the early and late stages.Results: All groups were comparable with regard to the preoperative characteristics except for the relatively smaller prostate volume in group A. The three-port LRP operations were performed successfully with only 8 cases conversion to the conventional LRP. None of any severe complications or conversion to ORP occurred. In group A, the mean operative time (OT) duration was 113.8 min, the mean estimated blood loss (EBL) was 94.2 ml, the mean drainage days was 4.0d, the mean hospitalization was 5.1 d, and 27.8% of the prostate specimen margins (PSM) were positive. The differences of OT, EBL, drainage days, hospitalization and transfusion in group A were statistically significant among the majority of the other groups (p<0.05). After undergoing the early stages of a learning curve analysis in three-port LRP, the EBL was obviously decreased.Conclusions: Three-port LRP is a novel technique that exhibits superior intraoperative advantages to the conventional LRP. Due to its less OT, EBL, drainage days, hospitalization and transfusion with a shorter learning curve, it should be recommended and popularized in the clinical practice!

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A novel “three-port” trocar placement technique for laparoscopic radical prostatectomy

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02051-y ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Ben Xu ◽

Yi-ji Peng ◽

Guo-zhong Ma ◽

Qian Zhang

Keyword(s):

Radical Prostatectomy ◽

Learning Curve ◽

Laparoscopic Radical Prostatectomy ◽

Trocar Placement ◽

Estimated Blood Loss ◽

Group A ◽

The Mean ◽

Group B ◽

Group D ◽

Placement Technique

Abstract Background To introduce a novel “three-port” trocar placement technique for laparoscopic radical prostatectomy (LRP) in prostate cancer (PCa) patients. Methods We retrospectively reviewed 300 patients with PCa who received surgical treatment between November 2010 and June 2015 at our institution. They were divided into group A, three-port LRP; group B, conventional four-five-port LRP; group C, open RP (ORP); and group D, robotic-assisted RP (RARP). A learning curve was analyzed by dividing patients of group A into the early and late stages. Results All groups were comparable with regard to the preoperative characteristics except for the relatively smaller prostate volume in group A. The three-port LRP operations were performed successfully with only 8 cases of conversion to the conventional LRP. None of any severe complications or conversion to ORP occurred. In group A, the mean operative time (OT) duration was 113.8 min, the mean estimated blood loss (EBL) was 94.2 ml, the mean drainage days was 4.0 days, the mean hospitalization was 5.1 days, and 27.8% of the prostate specimen margins (PSM) were positive. The differences of OT, EBL, drainage days, hospitalization, and transfusion in group A were statistically significant among the majority of the other groups (p < 0.05). After undergoing the early stages of a learning curve analysis in three-port LRP, the EBL was obviously decreased. Conclusions Three-port LRP is a novel technique that exhibits superior intraoperative advantages to the conventional LRP. Due to its less OT, EBL, drainage days, hospitalization, and transfusion with a shorter learning curve, it should be recommended and popularized in the clinical practice.

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A Novel “Three-port” Trocar Placement Technique for Laparoscopic Radical Prostatectomy

10.21203/rs.3.rs-60964/v1 ◽

2020 ◽

Author(s):

Ben Xu ◽

Hai-feng Song ◽

Cheng Luo ◽

Qian Zhang

Keyword(s):

Radical Prostatectomy ◽

Learning Curve ◽

Laparoscopic Radical Prostatectomy ◽

Trocar Placement ◽

Estimated Blood Loss ◽

Group A ◽

The Mean ◽

Group B ◽

Group D ◽

Placement Technique

Abstract Background: To introduce a novel “three-port” trocar placement technique for laparoscopic radical prostatectomy (LRP) in prostate cancer (PCa) patients.Methods: We retrospectively reviewed 300 patients with PCa who received surgical treatment between November 2010 and June 2015 at our institution. They were divided into group A: three-port LRP, group B: conventional four-five port LRP, group C: open RP (ORP) and group D: robotic-assisted RP (RARP). A learning curve was analyzed by dividing patients of group A into the early and late stages.Results: All groups were comparable with regard to the preoperative characteristics except for the relatively smaller prostate volume in group A. The three-port LRP operations were performed successfully with only 8 cases conversion to the conventional LRP. None of any severe complications or conversion to ORP occurred. In group A, the mean operative time (OT) duration was 113.8 min, the mean estimated blood loss (EBL) was 94.2 ml, the mean drainage days was 4.0d, the mean hospitalization was 5.1 d, and 27.8% of the prostate specimen margins (PSM) were positive. The differences of OT, EBL, drainage days, hospitalization and transfusion in group A were statistically significant among the majority of the other groups (p<0.05). After undergoing the early stages of a learning curve analysis in three-port LRP, the EBL was obviously decreased.Conclusions: Three-port LRP is a novel technique that exhibits superior intraoperative advantages to the conventional LRP. Due to its less OT, EBL, drainage days, hospitalization and transfusion with a shorter learning curve, it should be recommended and popularized in the clinical practice!

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Comparison of functional and oncological outcomes of innovative “three-port” and traditional “four-port” laparoscopic radical prostatectomy in patients with prostate cancer

BMC Urology ◽

10.1186/s12894-021-00787-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ben Xu ◽

Si-da Cheng ◽

Yi-ji Peng ◽

Qian Zhang

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Laparoscopic Radical Prostatectomy ◽

Positive Surgical Margin ◽

Oncological Outcomes ◽

Estimated Blood Loss ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background To compare the functional and oncological outcomes between innovative “three-port” and traditional “four-port” laparoscopic radical prostatectomy (LRP) in patients with prostate cancer (PCa). Methods We retrospectively collected the data of PCa patients treated at our institutions from June 2012 to May 2016. According to the inclusion criteria, a total of 234 patients were included in the study, including 112 in group A (four-port) and 122 in group B (three-port). The perioperatively surgical characteristics, functional and oncological outcomes were compared between groups. Results There were no statistical differences in the baseline parameters between these two groups. Compared with group A, the operative time (OT) and estimated blood loss (EBL) were significantly less in group B. On follow-up, the rate of positive surgical margin (PSM), prostate specific antigen (PSA) biochemical recurrence and continence after LRP did not show any statistically significant difference between the groups. An identical conclusion was also received in comparison of overall survival (OS) and biochemical recurrence-free survival (BRFS) between both groups. Conclusions Innovative “three-port” LRP can significantly shorten the OT and reduce the EBL compared with the traditional “four-port” LRP. Meanwhile, it does not increase the rate of PSM and PSA biochemical recurrence. “Three-port” LRP could be popularized in the future in view of its superior surgical technique, considerably better functional outcomes and remarkable oncological control.

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Laparoscopic Radical Prostatectomy: The Learning Curve of a Low Volume Surgeon

The Scientific World JOURNAL ◽

10.1155/2013/974276 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Anuar I. Mitre ◽

Mario F. Chammas ◽

José Eugênio A. Rocha ◽

Ricardo Jordão Duarte ◽

Gustavo Xavier Ebaid ◽

...

Keyword(s):

Radical Prostatectomy ◽

Blood Loss ◽

Learning Curve ◽

Operative Time ◽

Surgical Margin ◽

Positive Surgical Margin ◽

Estimated Blood Loss ◽

Group A ◽

Low Volume ◽

Group B

Objective. Analyze the learning curve for laparoscopic radical prostatectomy in a low volume program.Materials and Methods. A single surgeon operated on 165 patients. Patients were consecutively divided in 3 groups of 55 patients (groups A, B, and C). An enhancement of estimated blood loss, surgery length, and presence of a positive surgical margin were all considered as a function of surgeon’s experience.Results. Operative time was 267 minutes for group A, 230 minutes for group B, and 159 minutes for group C, and the operative time decreased over time, but a significant difference was present only between groups A and C (). Mean estimated blood loss was 328 mL, 254 mL, and 206 mL (). A conversion to open surgery was necessary in 4 patients in group A. Positive surgical margin rates were 29.1%, 21.8%, and 5.5% (). Eight patients in group A, 4 patients in group B, and one in group C had biochemical recurrence.Conclusion. Significantly less intraoperative complications were evident after the first 51 cases. All other parameters (blood loss, operative time, and positive surgical margins) significantly decreased and stabilized after 110 cases. Those outcomes were somehow similar to previous published series by high-volume centers.

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Comparison of functional and oncological outcomes of innovative “three-port” and traditional “four-port” laparoscopic radical prostatectomy in patients with prostate cancer

10.21203/rs.3.rs-64035/v3 ◽

2021 ◽

Author(s):

Ben Xu ◽

Si-da Cheng ◽

Yi-ji Peng ◽

Qian Zhang

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Laparoscopic Radical Prostatectomy ◽

Positive Surgical Margin ◽

Oncological Outcomes ◽

Estimated Blood Loss ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background: To compare the functional and oncological outcomes between innovative “three-port” and traditional “four-port” laparoscopic radical prostatectomy (LRP) in patients with prostate cancer (PCa).Methods: We retrospectively collected the data of PCa patients treated at our institutions from June 2012 to May 2016. According to the inclusion criteria, a total of 234 patients were included in the study, including 112 in group A (four-port) and 122 in group B (three-port). The perioperatively surgical characteristics, functional and oncological outcomes were compared between groups.Results: There were no statistical differences in the baseline parameters between these two groups. Compared with group A, the operative time (OT) and estimated blood loss (EBL) were significantly less in group B. On follow-up, the rate of positive surgical margin (PSM), prostate specific antigen (PSA) biochemical recurrence and continence after LRP did not show any statistically significant difference between the groups. An identical conclusion was also received in comparison of overall survival (OS) and biochemical recurrence-free survival (BRFS) between both groups. Conclusion: Innovative “three-port” LRP can significantly shorten the OT and reduce the EBL compared with the traditional “four-port” LRP. Meanwhile, it does not increase the rate of PSM and PSA biochemical recurrence. “Three-port” LRP could be popularized in the future in view of its superior surgical technique, considerably better functional outcomes and remarkable oncological control.

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Extraperitoneal robot-assisted laparoscopic radical prostatectomy: a single-center experience beyond the learning curve

World Journal of Urology ◽

10.1007/s00345-012-1014-y ◽

2012 ◽

Vol 31 (3) ◽

pp. 447-453 ◽

Cited By ~ 11

Author(s):

Guillaume Ploussard ◽

Laurent Salomon ◽

Bastien Parier ◽

Claude Clément Abbou ◽

Alexandre de la Taille

Keyword(s):

Radical Prostatectomy ◽

Learning Curve ◽

Laparoscopic Radical Prostatectomy ◽

Single Center ◽

Robot Assisted ◽

Single Center Experience

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Comparison of surgical, functional and oncological outcomes of innovatively “three-port” and traditionally “four-port” laparoscopic radical prostatectomy in patients with prostate cancer

10.21203/rs.3.rs-64035/v2 ◽

2020 ◽

Author(s):

Ben Xu ◽

Si-da Cheng ◽

Yi-ji Peng ◽

Qian Zhang

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Laparoscopic Radical Prostatectomy ◽

Positive Surgical Margin ◽

Oncological Outcomes ◽

Estimated Blood Loss ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background: To compare the surgical, functional and oncological outcomes between innovatively “three-port” and traditionally “four-port” laparoscopic radical prostatectomy (LRP) in patients with prostate cancer (PCa).Methods: We retrospectively collected the data of PCa patients treated at our institutions from June 2012 to May 2016. According to the inclusion criteria, a total of 234 patients were included in the study, including 112 in group A (four-port) and 122 in group B (three-port). The perioperatively surgical characteristics, functional and oncological outcomes were compared between groups.Results: None of statistical difference in the baseline parameters were detected between these two groups. Compared with group A, the operative time (OT) and estimated blood loss (EBL) were significantly less in group B. The similar follow-up results were obtained in the rate of positive surgical margin (PSM), prostate specific antigen (PSA) biochemical recurrence and continence after LRP without any statistically significant difference. An identical conclusion was also received in comparison of overall survival (OS) and biochemical recurrence-free survival (BRFS) between both groups. Conclusion: Innovatively “three-port” LRP can significantly shorten the OT and reduce the EBL compared with the traditionally “four-port” LRP. Meanwhile, it does not increase the positive rate of PSM and PSA biochemical recurrence. “Three-port” LRP could be popularized in the future in view of its superior surgical technique, considerably functional outcomes and remarkably oncological control.

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