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A laparoscopically naïve yet experienced open surgeon successfully transferred open surgical skills to a laparoscopic environment in 8 to 12 cases using a robotic interface. This outcome is comparable to the reported experience of skilled laparoscopic surgeons after more than 100 LRPs.

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In this prospective survey of referring physicians, we investigated whether and how Ga-labeled prostate-specific membrane antigen 11 (Ga-PSMA-11) PET/CT affects the implemented management of prostate cancer patients with biochemical recurrence (BCR). We conducted a prospective survey of physicians (NCT02940262) who referred 161 patients with prostate cancer BCR (median prostate-specific antigen value, 1.7 ng/mL; range, 0.05-202 ng/mL). Referring physicians completed one questionnaire before the scan to indicate the treatment plan withoutGa-PSMA-11 PET/CT information (Q1; = 101), one immediately after the scan to denote intended management changes (Q2; = 101), and one 3-6 mo later to document the final implemented management (Q3; = 56). The implemented management was also obtained via electronic chart review or patient contact ( = 45). A complete documented management strategy (Q1 + Q2 + implemented management) was available for 101 of 161 patients (63%). Seventy-six of these (75%) had a positiveGa-PSMA-11 PET/CT result. The implemented management differed from the prescan intended management (Q1) in 54 of 101 patients (53%). The postscan intended management (Q2) differed from the prescan intended management (Q1) in 62 of 101 patients (61%); however, these intended changes were not implemented in 29 of 62 patients (47%). Pelvic nodal and extrapelvic metastatic disease on Ga-PSMA-11 PET/CT (PSMA T0N1M0 and PSMA T0N1M1 patterns) was significantly associated with implemented management changes ( = 0.001 and 0.05). Information fromGa-PSMA-11 PET/CT brings about management changes in more than 50% of prostate cancer patients with BCR (54/101; 53%). However, intended management changes early after Ga-PSMA-11 PET/CT frequently differ from implemented management changes.

The implementation of guidelines and proctoring recommendations is necessary to protect surgeons, proctors, institutions and, above all, the patients who are associated with the institutional introduction of a robot assisted radical prostatectomy program. With no current guidelines we anticipate this article will serve as a catalyst of interorganizational discussion to initiate regulatory oversight of surgeon certification and proctorship.