Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?

Abstract

Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience.Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates.Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups.Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP.

Analysis of the Learning Curve of Surgeons without Previous Experience in Laparoscopy to Perform Robot-Assisted Radical Prostatectomy

“…Machado and colleagues [ 14 ] reported that surgeons with more than 200 LRP cases obtained similar oncological results in the first 60 cases using RARP. They found mean operating time of 236 minutes and blood loss of 245.6 ml.…”

Does Prior Laparoscopic and Open Surgery Experience Have Any Impact on Learning Curve in Transition to Robotic Surgery?

“…In another quite similar study, the first 60 RRP and the last 60 LRP results of 3 surgeons with over 200 LRP experience were compared and it was reported that surgery time, blood loss volume and surgical margin positivity were significantly higher in patients who underwent robotic prostatectomy (153 mins-236 mins, 202 ml-244 ml and 12.5-31.6%, respectively). However, potency and continence rates were similar with each other or in favor of robotic surgery (16). On the other hand, in another study in which first 50 robot-assisted laparoscopic prostatectomy (ARP) and first 50 open radical retropubic prostatectomy (ORRP) results of a surgeon without previous laparoscopy experience was evaluated, operative time and blood loss volume were found to be lower in ARP than in ORRP, meanwhile complication, surgical margin positivity, continence and potency rates were found to be similar.…”

Prospective evaluation of vesicourethral anastomosis outcomes in robotic radical prostatectomy during early experience in a university hospital

“…In the first reported series in Brazil, Colombo Jr et al reported mean estimated bleeding of 480mL (100-1800) and transfusion necessary in two patients (2%). One study from Tobias-Machado and another from Lott found mean blood loss of 245.6mL and 212mL respectively ( 21 , 22 ). In our series, mean EBL was 95mL (±158), no patients had blood transfusions during surgery, but two (3.3%) required it during postoperative period.…”

“…Reports from initial series in some high volume centers showed median surgical duration from 215 to 274 minutes ( 24 , 25 ). Series from our country reported mean or median surgical times from 175 to 298 minutes ( 3 , 21 , 22 , 26 ). In 2005 Patel et al described an extremely short mean operative time of 141 min.…”

“…Publications from high-volume centers have found rates of continence (up to 1 pad/day) at 6 months of 71.7% to 93% on initial series ( 24 , 30 ). One report from Brazil found 6 months continence rates of 93.3% ( 21 ). Lott et al described continence rates of 88% in 6 months ( 22 ).…”