It Is Safe to Teach Residents Laser Prostate Surgery in the Private Practice Setting

• Published in: Urology (Ridgewood, N.J.) Vol. 81; no. 3; pp. 629 - 633
• Main Authors: Herrick, Benjamin W, Yap, Ronald L
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2013; Elsevier
• Subjects: Aged; Biological and medical sciences; Clinical Competence; Humans; Internship and Residency - standards; Laser Therapy; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Patient Safety; Private Practice; Prostatectomy - education; Prostatectomy - methods; Retrospective Studies; Urology; Nephrology; Treatment; Surgery; Laser; Resident; Urogenital system; Prostate; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2012.09.059

Objective To examine the effect of resident involvement on laser prostate surgery outcomes within a urology group in a private practice setting. Materials and Methods Patients with ≥6 months of follow-up data who had undergone holmium laser ablation of the prostate by a single surgeon (R.L.Y.) within a private urology group were included in the present study. The patients were divided into 2 groups, with resident involvement in 1 group and no resident involvement in 1 group. The preoperative, intraoperative, and postoperative parameters were reviewed. The outcomes variables included changes in the International Prostate Symptom Score, quality of life scores, postvoid residual urine volumes, and reoperation rates. Statistical analysis used a 2-tailed Student t test with a significance level of .05. Results Of 153 holmium laser ablations of the prostate, 79 (52%) met the inclusion criteria. Of the 79 cases, 42 (53%) involved a resident. No statistically significant differences were found among the 2 groups in preoperative patient characteristics, including age, Society of Anesthesiologists score, prostate-specific antigen level, postvoid residual urine volume, International Prostate Symptom Score, or quality of life. The operative times were significantly longer in the resident group (57 vs 46 minutes, P  = .05). Postoperatively, no differences in the mean values were found in postvoid residual urine volume (56 vs 64 mL, P  = .73), change in International Prostate Symptom Score (11.5 vs 9.7, P  = .44), change in quality of life score (−2.1 vs −1.3, P  = .13), or reoperation rate (5% vs 11%, P  = .19). Conclusion The operative times were longer in the resident group, reflecting the inherent time taken to teach the residents the procedure. The results from the present study suggest that it is feasible to safely teach residents new surgical technology such as holmium laser ablation of the prostate in a nonacademic private practice setting without adversely affecting surgical performance or outcomes.