The initial learning curve for open radical prostatectomy / Curva de aprendizado inicial da prostatectomia radical retropúbica

AUTOR(ES)

Fernando José Akira Saito

DATA DE PUBLICAÇÃO

2010

RESUMO

Introduction: The learning curve is a period of skills improvement. Procedures are carried through with longer operating time, high risk of surgical complications and sub optimal functional outcomes. We have analyzed the residentsinitial learning curve in open radical prostatectomy in our institution. Method: Between June of 2006 and January of 2008, 184 open radical prostatectomies have been performed in our service by five senior residents in Urology. We prospectively evaluated: operating time, blood loss, blood transfusion rate, positive surgical margins, intra-operative complications and early functional outcomes. Results: an average of 37 open radical prostatectomies was performed by each resident. Medium PSA was 9,3ng/mL; clinical stage T1c in 71% of the patients. The pathological stage was pT2 (73%), pT3 (23%), pT4 (4%) and Gleason score was 54% (Gleason <7), 33% (Gleason 7) and 13% (Gleason >7). The medium operating time was 140 minutes, medium blood loss of 488 mL and positive margins were found in 23% during the first 30 cases. Early functional outcomes (less than 6 months after surgery) revealed 89% of urinary continence, 43% of normal erectile function and 7% of biochemical recurrence. Conclusion: During the initial learning curve significant reduction in operating time occurs after first 20 procedures, blood loss and transfusion improves after 29 prostatectomies and positive margins remain stable during the first 30 patients (23%).

ASSUNTO(S)

prostatectomia retropúbica/educação prostatectomy/education itraoperative complications residency and internship neoplasias da próstata internato e residência complicações intra-operatórias prostatic neoplasm

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