Skip to main content
Log in

Evaluation of complications in endoscopic extraperitoneal radical prostatectomy in a modular training programme: a multicentre experience

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Objectives

Structured mentor-based “modular surgical training (MST)” has proved to be an effective way to teach endoscopic extraperitoneal radical prostatectomy (EERPE) safely to residents, even those without previous experience in laparoscopic surgery. We report on complications in early patient series from two centres where EERPE was established by MST held at the same teaching centre.

Methods

Three trainees from two departments underwent MST at the same teaching centre. Thereafter, they were supervised by their mentor at their hospital. Peri-operative and post-operative complications of the first 245 (centre 1) and 288 (centre 2) cases were analysed retrospectively by the revised Clavien classification and compared to a large series (n = 1300) from the teaching centre. P < 0.05 were considered significant.

Results

In total, 427 (80.1%) patients were without complications at the training centres. Intra-operative complications occurred in 8 (1.6%) patients. Among 98 (18.3%) patients with post-operative complications, 41 (7.7%) and 7 (1.3%) patients with Clavien grade I and II complications required no or pharmacological treatment, respectively. Totally, 40 (7.5%) patients required surgical intervention (Clavien grade III). Grade IV and V complications were observed in 9 (1.7%) and 1 (0.2%) cases, respectively. A comparison of complications from the training centres and the teaching centre revealed no statistically significant difference.

Conclusions

Novice laparoscopic surgeons can safely learn EERPE by a structured, mentor based, modular surgical training programme without putting patients at risk. The complication rates in early patient series are low and comparable to those of the teaching centre.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Rozet F, Arroyo C, Cathelineau X, Barret E, Prapotnich D, Vallancien G (2004) Extraperitoneal standard laparoscopic radical prostatectomy. J Endourol 18:605–609

    Article  PubMed  Google Scholar 

  2. Stolzenburg JU, Rabenalt R, Tannapfel A, Liatsikos EN (2006) Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy. Urology 67:17–21

    Article  PubMed  Google Scholar 

  3. Stolzenburg JU, Rabenalt R, Do M, Truss MC, Burchardt M, Herrmann TR, Schwalenberg T, Kallidonis P, Liatsikos EN (2007) Endoscopic extraperitoneal radical prostatectomy: the University of Leipzig experience of 1,300 cases. World J Urol 25:45–51

    Article  PubMed  Google Scholar 

  4. Guillonneau B, Bermudez H, Gholami S, El FH, Gupta R, Adorno RJ, Baumert H, Cathelineau X, Fromont G, Vallancien G (2003) Laparoscopic partial nephrectomy for renal tumor: single center experience comparing clamping and no clamping techniques of the renal vasculature. J Urol 169:483–486

    Article  PubMed  CAS  Google Scholar 

  5. Rassweiler J, Frede T, Teber D, van Velthoven RF (2005) Laparoscopic radical cystectomy with and without orthotopic bladder replacement. Minim Invasive Ther Allied Technol 14:78–95

    Article  PubMed  Google Scholar 

  6. Stolzenburg JU, Rabenalt R, Do M, Tannapfel A, Truss MC, Liatsikos EN (2006) Nervesparing endoscopic extraperitoneal radical prostatectomy: University of Leipzig technique. J Endourol 20:925–929

    Article  PubMed  Google Scholar 

  7. Turk IA, Giessing M, Deger S, Davis JW, Fabrizio MD, Schonberger B, Jordan GH, Loening SA (2003) Laparoscopic live donor right nephrectomy: a new technique with preservation of vascular length. Transplant Proc 35:838–840

    Article  PubMed  CAS  Google Scholar 

  8. Guillonneau B, Abbou CC, Doublet JD, Gaston R, Janetschek G, Mandressi A, Rassweiler JJ, Vallancien G (2001) Proposal for a “European Scoring System for Laparoscopic Operations in Urology”. Eur Urol 40:2–6

    Article  PubMed  CAS  Google Scholar 

  9. Stolzenburg JU, Schwaibold H, Bhanot SM, Rabenalt R, Do M, Truss M, Ho K, Anderson C (2005) Modular surgical training for endoscopic extraperitoneal radical prostatectomy. BJU Int 96:1022–1027

    Article  PubMed  Google Scholar 

  10. Stolzenburg JU, Rabenalt R, Do M, Horn LC, Liatsikos EN (2006) Modular training for residents with no prior experience with open pelvic surgery in endoscopic extraperitoneal radical prostatectomy. Eur Urol 49:491–498

    Article  PubMed  Google Scholar 

  11. Stolzenburg JU, Rabenalt R, Do M, Lee B, Truss MC, Schwaibold H, Burchardt M, Jonas U, Liatsikos EN (2006) Categorisation of complications of endoscopic extraperitoneal and laparoscopic transperitoneal radical prostatectomy. World J Urol 24:88–93

    Article  PubMed  Google Scholar 

  12. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  13. Ghavamian R, Schenk G, Hoenig DM, Williot P, Melman A (2004) Overcoming the steep learning curve of laparoscopic radical prostatectomy: single-surgeon experience. J Endourol 18(6):567–571

    Article  PubMed  Google Scholar 

  14. Katz R, Nadu A, Olsson LE, Hoznek A, de La TA, Salomon L, Abbou CC (2003) A simplified 5-step model for training laparoscopic urethrovesical anastomosis. J Urol 169:2041–2044

    Article  PubMed  Google Scholar 

  15. Teber DF, Dekel YF, Frede TF, Klein JF, Rassweiler J (2005) The Heilbronn laparoscopic training program for laparoscopic suturing: concept and validation. J Endourol 19(2):230–238

    Article  PubMed  Google Scholar 

  16. Frede T, Erdogru T, Zukosky D, Gulkesen H, Teber D, Rassweiler J (2005) Comparison of training modalities for performing laparoscopic radical prostatectomy: experience with 1,000 patients. J Urol 174:673–678

    Article  PubMed  Google Scholar 

  17. Skrekas T, Mochtar CA, Lagerveld BW, de Reijke TM, van Velthoven RF, Peltier A, de la Rosette JJ, Laguna MP (2006) Mentor-initiated approach in laparoscopic radical prostatectomy. J Endourol 20:831–835

    Article  PubMed  Google Scholar 

  18. Sugiono M, Teber D, Anghel G, Gozen AS, Stock C, Hruza M, Frede T, Klein J, Rassweiler JJ (2007) Assessing the predictive validity and efficacy of a multimodal training programme for laparoscopic radical prostatectomy (LRP). Eur Urol 51:1332–1339

    Article  PubMed  Google Scholar 

  19. Fabrizio MD, Tuerk I, Schellhammer PF (2003) Laparoscopic radical prostatectomy: decreasing the learning curve using a mentor initiated approach. J Urol 169:2063–2065

    Article  PubMed  Google Scholar 

  20. Gonzalgo ML, Pavlovich CP, Trock BJ, Link RE, Sullivan W, Su LM (2005) Classification and trends of perioperative morbidities following laparoscopic radical prostatectomy. J Urol 174:135–139

    Article  PubMed  Google Scholar 

  21. Guillonneau B, Rozet F, Cathelineau X, Lay F, Barret E, Doublet JD, Baumert H, Vallancien G (2002) Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol 167:51–56

    Article  PubMed  Google Scholar 

  22. Permpongkosol S, Link RE, Su LM, Romero FR, Bagga HS, Pavlovich CP, Jarrett TW, Kavoussi LR (2007) Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J Urol 177:580–585

    Article  PubMed  Google Scholar 

  23. Keeley FX Jr, Eden CG, Tolley DA, Joyce AD (2007) The British Association of Urological Surgeons: guidelines for training in laparoscopy. BJU Int 100:379–381

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

There is no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Roman Ganzer.

Additional information

R. Ganzer and R. Rabenalt contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ganzer, R., Rabenalt, R., Truss, M.C. et al. Evaluation of complications in endoscopic extraperitoneal radical prostatectomy in a modular training programme: a multicentre experience. World J Urol 26, 587–593 (2008). https://doi.org/10.1007/s00345-008-0291-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-008-0291-y

Keywords

Navigation