Eur Urol Suppl 2007;6(2):255 929 CORRElATION OF POSTOPERATIvE hEMOglObIN lEvElS ANd blOOd lOSSAFTER lAPAROSCOPIC RAdICAl PROSTATECTOMY Wenske S. 1 , Romero Otero J. 1 , Rizvi A. 1 , Quraishi I. 1 , Lilja H. 2 , Guillonneau B. 1 , Touijer K. 1 1 Memorial Sloan-Kettering Cancer Center, Urology, New York, United States of America, 2 Memorial Sloan-Kettering Cancer Center, Clinical Laboratories, Surgery (Urology) and Medicine, New York, United States of America Introduction & Objectives: Due to the efect of the pneumoperitoneum, intraoperative bleeding is relatively limited during laparoscopic radical prostatectomy (LRP); postoperative hemorrhage however, remains a potential complication. Current postoperative assessment is based on the open radical prostatectomy experience, a procedure with a diferent blood loss profle. Herein we evaluate for the ideal timing and frequency of hemoglobin (HGB) measurements after LRP. Material & Methods: 688 men underwent a transperitoneal LRP between January 2003 and March 2006. All patients had HGB measured preoperatively (baseline), in the immediate postoperative period (within 30 minutes of surgery completion) and on postoperative day 1 (18h to 24h postoperatively). 205 patients had an additional HGB measurement 3 to 4 hours postoperatively. We created a linear regression statistical model to evaluate the relationship between time and postoperative hemoglobin levels following LRP, controlling for intraoperative estimated blood loss (EBL) and intravenous fuid infusion (IVF). Results: Median EBL was 300 ml (interquartile range 200 - 400 ml); median IVF was 2600 ml (interquartile range 2125 - 3000 ml). The median HGB level taken immediately postoperatively was 13.3 g/dl vs. 14.9 g/dl at baseline; HGB levels continued to decrease up to 1 day postoperatively (median of 12.1 g/dl). Controlling for preoperative HGB levels, EBL and IVF, postoperative HGB level was signifcantly associated with time (p<0.0005) with a high start up point (immediate postoperative HGB) followed by an initial steep decline in the frst 4 to 6 hours. Conclusions: Accurate assessment of blood loss after LRP is best measured 4 to 6 hours after the operation. Due to the pneumoperitoneum efect and resulting fuid shift, immediate postoperative hemoglobin measurement is a poor refection of the blood loss and not predictive of the fnal HBG level. Therefore, omitting this measurement is safe and cost efcient. 930 hEAlTh RElATEd qUAlITY OF lIFE AFTER lAPAROSCOPIC RAdICAl PROSTATECTOMY Wyler S., Ruszat R., Lenggenhager C., Straumann U., Forster T., Sulser T., Gasser T., Bachmann A. University Hospital Basel, Urology, Basel, Switzerland Introduction & Objectives: To investigate health related quality of life changes after laparoscopic radical prostatectomy (LRP) and assess long-term outcome. Material & Methods: Prospective evaluation of QoL with the questionnaires of the EORTC QLQ C-30 and the prostate specifc module PR25 preoperatively (t0) as well as postoperatively after 1-3 months (t1), 4-12 months (t2), 13-24 months (t3) and yearly thereafter for up to 5 years (t4-t6). Statistical analysis was performed with the Mann Whitney test and the Kruskal Wallis test comparing follow-up categories to baseline and with each other for functional and symptom scales. Results: 590 questionnaires from 350 patients operated by LRP from 2001- 2006 were available for analysis. The mean follow-up was 18.1± 15.2 months. For t0-t6 89, 137, 146, 84, 70, 46 and 18 questionnaires were available for analysis. Global health was signifcantly impaired for t1 (p<0.001) and returned to baseline for t2-t6. Physical functioning was impaired for t1 (p<0.001) and returned to baseline values for t2-t6. Emotional functioning was signifcantly improved (p=0.002) for t2-t6 compared to baseline. Role functioning, sexual functioning and social functioning remained impaired for t1-t5 and reached baseline for t6. Symptom scales were not signifcantly afected except for pain and fatigue for t1 (p<0.001) reaching baseline thereafter as well as bowel symptoms for t1 (p=0.004). Conclusions: Global health and physical functioning are only signifcantly impaired for 1-3 months after operation and reach baseline thereafter. Emotional functioning improves signifcantly after operation and remains stable. Role, social and sexual functioning are signifcantly impaired but reach baseline late. 931 A STRUCTUREd PROgRAM TO TRAIN RESIdENTS IN lAPAROSCOPIC RAdICAl PROSTATECTOMY Pow-Sang J., Rodriguez A. H. Lee Moftt Cancer Center and Research Institute at the University of South Florida, Urology, Tampa, United States of America Introduction & Objectives: Laparoscopy is becoming a standard approach in oncologic urology surgery. As residency programs adjust their training of residents and fellows, the need arises to evaluate and optimize the training in advanced laparoscopic procedures. We seek to determine the value of a structured training program and the number of extraperitoneal laparoscopic radical prostatectomies required for a trainee to obtain profciency with the procedure. Material & Methods: 6 residents and 2 fellows underwent systematic training in laparoscopic radical prostatectomy. The training was divided in 4 phases. Phase I: immersion in the current literature and systematic review of available instructional video material. Phase II: Dry lab training to acquire suturing skills to perform a urethrovesical anastomosis. Phase III: Participating as assistant in 5 laparoscopic radical prostatectomies. Phase IV: Performance of a 10-step laparoscopic radical prostatectomy starting with case 6. The performance of the procedure in less than 4 hours and the subjective evaluation by the proctor were considered as endpoint for achieving profciency with the procedure. Results: The vesico-urethral anastomosis was the most difcult part of the procedure and was optimized by the trainee becoming profcient in the dry laboratory. The number of cases to achieve profciency ranged from 10-25 with a median of 20 cases. Conclusions: With an established, structured training program, a mean of 20 cases are required per trainee to achieve profciency in performing extraperitoneal laparoscopic radical prostatectomy. Refnements in the training process might decrease the total number needed to 15 cases or less. 932 lAPAROSCOPIC RAdICAlPROSTATECTOMY: ThE IMPACT OF TRAININg ON SERvICE PROvISION Chabert C., Merilees D., Eden C. Royal Surrey County Hospital, Department of Urology, Guildford, United Kingdom Introduction & Objectives: We report the results of our patients undergoing laparoscopic radical prostatectomy (LRP) with and without a trainee performing a substantial part of the case. Material & Methods: 771 consecutive cases of laparoscopic radical prostatectomy were performed or supervised by a single surgeon during a 7.5 year period, of which 114 (15%) were training cases. A fve port transperitoneal technique was used in the frst 111 patients and an extra peritoneal approach in the remaining 660 men. Continuous variables were compared using an independent samples t-test and rates compared with Fisher’s exact test. Results: With the exception of BMI, which was lower in training cases (median=25.0 vs. 26.0, p=0.02), patient demographics were similar. The only conversion occurred during a non-training operation. The median operative times for training and non-training cases were 200 min and 175 min, respectively (p=0.0007), gland weight=52.0g and 57.5g (p=0.08), blood loss=200 ml each (p=0.43), post- operative hospitalization=3.0 days each (p=0.08), duration of catheterization=10.0 days each (p=0.98), complication rates=7.0% and 4.8% (p=0.45), positive margin rates=14.0% and 17.4% (p=0.46), biochemical recurrence rates=1.8% and 2.1% (p=1.00) at a mean follow-up of 10.3 and 26.9 months, pad-free rates= 89.5% and 95.2% (p=0.04). Trainees were not permitted to perform the posterior or apical dissection in nerve-preserving cases so potency rates cannot be compared. Conclusions: Despite being performed on slimmer patients, training cases took a median of 25 minutes longer to complete than non-training cases. However, blood loss, duration of hospitalization and catheterization, complications rates and cancer outcomes were similar. The higher pad-free rate following non-training cases is likely to be due to the 16.6 month longer follow-up in this group. Supervised training during of LRP maintains the quality of the procedure but adds extra time to each case. Hospital managers must accept that training takes time but is essential for the dissemination of surgical skills.