The learning curve for laparoscopic radical prostatectomy: An international multicenter study

Fernando P. Secin, Caroline Savage, Claude Abbou, Alexandre De La Taille, Laurent Salomon, Jens Rassweiler, Marcel Hruza, Franois Rozet, Xavier Cathelineau, Gunther Janetschek, Faissal Nassar, Ingolf Turk, Alex J. Vanni, Inderbir S. Gill, Philippe Koenig, Jihad H. Kaouk, Luis Martinez Pineiro, Vito Pansadoro, Paolo Emiliozzi, Anders BjartellThomas Jiborn, Christopher Eden, Andrew J. Richards, Roland Van Velthoven, Jens Uwe Stolzenburg, Robert Rabenalt, Li Ming Su, Christian P. Pavlovich, Adam W. Levinson, Karim A. Touijer, Andrew Vickers, Bertrand Guillonneau

Research output: Contribution to journalArticlepeer-review


Purpose It is not yet possible to estimate the number of cases required for a beginner to become expert in laparoscopic radical prostatectomy. We estimated the learning curve of laparoscopic radical prostatectomy for positive surgical margins compared to a published learning curve for open radical prostatectomy. Materials and Methods We reviewed records from 8,544 consecutive patients with prostate cancer treated laparoscopically by 51 surgeons at 14 academic institutions in Europe and the United States. The probability of a positive surgical margin was calculated as a function of surgeon experience with adjustment for pathological stage, Gleason score and prostate specific antigen. A second model incorporated prior experience with open radical prostatectomy and surgeon generation. Results Positive surgical margins occurred in 1,862 patients (22%). There was an apparent improvement in surgical margin rates up to a plateau at 200 to 250 surgeries. Changes in margin rates once this plateau was reached were relatively minimal relative to the CIs. The absolute risk difference for 10 vs 250 prior surgeries was 4.8% (95% CI 1.5, 8.5). Neither surgeon generation nor prior open radical prostatectomy experience was statistically significant when added to the model. The rate of decrease in positive surgical margins was more rapid in the open vs laparoscopic learning curve. Conclusions The learning curve for surgical margins after laparoscopic radical prostatectomy plateaus at approximately 200 to 250 cases. Prior open experience and surgeon generation do not improve the margin rate, suggesting that the rate is primarily a function of specifically laparoscopic training and experience.

Original languageEnglish (US)
Pages (from-to)2291-2296
Number of pages6
JournalJournal of Urology
Issue number6
StatePublished - Dec 2010


  • Laparoscopy
  • Learning
  • Prostatectomy
  • Prostatic neoplasms

ASJC Scopus subject areas

  • Urology


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