Does the experience of the bedside assistant effect the results of robotic surgeons in the learning curve of robot assisted radical prostatectomy?

Abstract

Introduction: The success of the robot assisted radical prostatectomy (RARP) procedures depend on a successful team, however the literature focuses on the performance of a console surgeon. The aim of this study was to evaluate surgical outcomes of the surgeons during the learning curve in relation to the bedside assistant's experience level during RARP. Materials and Methods: We retrospectively reviewed two non - laparoscopic, beginner robotic surgeon's cases, and we divided the patients into two groups. The first surgeon completed the operations on 20 patients with a beginner bedside assistant in February - May 2009 (Group-1). The second surgeon completed operations on 16 patients with an experienced (at least 150 cases) bedside assistant in February 2015 - December 2015 (Group-2). The collected data included age, prostate volume, prostate specific antigen (PSA), estimated blood loss, complications and percent of positive surgical margins. In addition, the elapsed time for trocar insertion, robot docking, console surgery, specimen extraction and total anesthesia time were measured separately. Results: There were no significant differences between the groups in terms of age, comorbidity, prostate volume, PSA value, preoperative Gleason score, number of positive cores, postoperative Gleason score, pathological grade, protection rate of neurovascular bundles, surgical margin positivity, postoperative complications, length of hospital stay, or estimated blood loss. The robot docking, trocar placement, console surgery, anesthesia and specimen extraction times were significantly shorter in group 2 than they were in group 1 (17.75 ± 3.53 min vs. 30.20 ± 7.54 min, p ≤ 0.001; 9.63 ± 2.71 min vs. 14.40 ± 4.52 min, p = 0.001; 189.06 ± 27.70 min vs. 244.95 ± 80.58 min, p = 0.01; 230.94 ± 30.83 min vs. 306.75 ± 87.96 min, p = 0.002; 10.19 ± 2.54 min vs. 17.55 ± 8.79 min, p = 0.002; respectively). Conclusion: Although the bedside assistant's experience in RARP does not appear to influence the robotic surgeon's oncological outcomes during the learning curve, it may reduce the potential complications by shortening the total operation time.

The role of the bedside assistant in robot-assisted surgery: A critical synthesis

“…The majority of these (21) proved irrelevant, while the full text of one was not in English (Pograjec & Hubert 2019). Two records (Cimen et al 2019a, 2019b) were also excluded for lack of rigour/poor quality as apparently the same dataset was used to achieve different conclusions by excluding one or another variable, and whereas a combined analysis would have seemed more trustworthy. Finally, one other record was excluded (Goldenberg et al 2018) as it proved to be the abstract of an included study (Yu et al 2021).…”

Serving as a bedside surgeon before performing robotic radical prostatectomy improves surgical outcomes

“…Operation time is another important factor in robotic surgery, as we reported in our previous study, it decreases with more experience for both the console surgeon and the bedside assistant ( 21 ). Guzzo et al reported that as the surgeons become more experienced at the bedside, they become more proficient in trocar port placement, docking and undocking, instrumentation and troubleshooting with greater accuracy ( 22 ).…”

Impact of bedside assistant on outcomes of robotic thyroid surgery

“…[ 20 – 23 ] The importance of bedside assistants in terms of surgical outcomes has also been shown in various robotic procedures, including complex gastrointestinal surgery, bariatric surgery, and prostatectomy. [ 13 – 16 ] However, little attention has been paid to the role of the assistant in robotic thyroid surgery. During BABA robotic thyroidectomy, the bedside assistant has important roles, including aligning the patient and robot in appropriate positions, which enables better control of the console surgeon, changing and mounting devices efficiently, and providing effective suction and irrigation to make a clear surgical field of view.…”

“…[ 13 ] Previous studies have demonstrated that higher levels of experience of the surgical assistants are associated with reduced operative times, less blood loss, and lower overall complication rates. [ 13 – 16 ] Moreover, participation of trainees resulted in higher rates of anastomosis leakage, readmissions, re-interventions, and complications. [ 14 ] In contrast, Abu-Ghanem et al [ 17 ] found that assistant's experience levels had no influence on operative outcomes.…”