Prostate Artery Operator Learning Curves, Affirmation of the Safety of Widespread Adaption

Excerpt

In this edition of cardiovascular and interventional radiology, Powell et al. report on operator learning curves for prostatic artery embolization (PAE) [1]. Operator learning curve data are often found in the surgical literature, however, less robust in the interventional radiology literature but of equivalent importance. Specifically, in PAE, this is an important avenue of investigation for several reasons. First, while a number of potential issues have been raised by Urologic associations such as the American Urologic Association (AUA), one consistent refrain is that the procedure may be too technically challenging to be performable by all [2]. Second, while the basic skill sets needed are taught by all interventional radiology training programs, given the technical challenges PAE presents, it is of interest for interventional radiologists to know how many cases will be needed to gain technical proficiency. The current paper is the first to provide data on such questions finding that many technical factors such as procedural time (76 procedures), fluoroscopic time (78 procedures), and contrast volume (73 procedures) had their maximal inflection points closely clustered together and around 75 procedures. This would suggest that interventional radiologists should expect to gain technical proficiency at around 75 procedures; however, it should also be noted that the current authors had to gain this experience on their own. This differs from current and future trainees who will not only have the benefit of performing their first cases during training, but also may have this curve shortened by receiving this expert hands-on training that did not exist for the current authors. Therefore, future analysis of providers who have the benefit of performing PAE during training may find that 75 procedures represent the largest number of cases needed prior to proficiency. Finally, it is important to note these numbers are not substantially different than similar analysis of other benign prostatic hyperplasia (BPH) interventions for lower urinary tract symptoms (LUTS) [3, 4], which would refute concerns raised about PAE in this regard. …