Temporal Relationship Between Positive Margin Rate After Laparoscopic Radical Prostatectomy and Surgical Training REPLY

OBJECTIVES To evaluate the potential impact of the experience of the first assistant on the positive surgical margin rate (PSMR) after laparoscopic radical prostatectomy (LRP). The impact of training surgical residents and fellows on patient outcomes is difficult to quantify. METHODS A single-institution prospective database of 303 patients who underwent LRP between 2003 and 2008 was evaluated. The potential impact of the experience of the first assistant on the PSMR was evaluated by examining the relationship between the PSMR and the time of the academic year. Multivariable logistic regression analysis was used to adjust for patient age, Gleason's sum, tumor density, and pathologic stage. RESULTS Overall positive margin rate was 18.2%. Positive margin rate for July and August (14/45, 31.1%) was significantly higher than for the remaining 10 months (41/258, 15.9%) P = .015. The increased risk of positive margin in July/August remained significant after adjusting for age, Gleason's sum, tumor density, and pathologic stage (OR 2.65, 95% CI 1.21-5.79, P = .015) CONCLUSIONS LRP performed with the first assistant in the first 2 months of the academic training year have a significantly higher PSMR. UROLOGY 77: 626-630, 2011. (C) 2011 Elsevier Inc.