How many procedures are needed to achieve learning curve of Millin simple laparoscopic prostatectomy?

Background: Aim of our study was to evaluate learning curve of the Millin simple prostatectomy analyzing three expert laparoscopic surgeons.

Methods: Learning curve of 3 expert laparoscopic surgeons with excellent radical prostatectomy training was evaluated. Surgeon 1 had more than 20 years of experience, while other surgeons had 10 years of experience. The first 45 procedures of the surgeons were considered for analysis. The cumulative sum (CUSUM) technique, one of the methods developed to monitor the performance and quality of the industrial sector, was adopted to analyze learning curves. The variables included to evaluate learning curve of the surgeons were: operative time (OT), hospitalization (HO) and complication rate.

Results: Overall 135 patients were included in the analysis. Median age was 68 (64/74), median prostate volume was 83 (75/97), median Qmax 9 mL/s (6/11) and median IPSS=20 (18/22). Complications included: 9/135 (7%) transfusion, 4/135 (3%) Urinary retention, 3/135 (2%) fever, 1/35 (<1%) reintervention and 1/135 (<1%) conversion. Surgeon 1 presented a lower median operative time when compared to surgeon 2 and 3. No significant differences were recorded in terms of hospitalization, blood loss and transfusion rate as well as postoperative outcomes. According to the CUSUM analysis the number of procedures needed to achieve a plateau in surgical time is 10/15 procedures.

Conclusions: According to our results 15 procedures are needed to reach a plateau in surgical time for trained laparoscopic surgeons.