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

Abstract

Introduction: To evaluate the influence of previous experience as bedside assistants on patient selection, perioperative and pathological results in robot assisted laparoscopic radical prostatectomy. Materials and Methods: The first 50 cases of two robotic surgeons were reviewed retrospectively. Group 1 consisted of the first 50 cases of the surgeon with previous experience as a robotic bedside assistant between September 2016-July 2018, while Group 2 included the first 50 cases of the surgeon with no bedside assistant experience between February 2009-December 2009. Groups were examined in terms of demographics, prostate volume, presence of median lobe, prostate specific antigen (PSA), preoperative Gleason score, positive core number, clinical stage, console surgery time, estimated blood loss, postoperative Gleason score, pathological stage, positive surgical margin rate, postoperative complications, length of hospital stay and biochemical recurrence rate. Results: Previous abdominal surgery and the presence of median lobe hypertrophy rates were higher in Group 1 than in Group 2 (20% vs. 4%, p=0.014; 24% vs. 6%, p=0.012; respectively). In addition, patients in Group 1 were in a higher clinical stage than those in Group 2 (cT2: 70% vs. 28%, p=0.001). Median console surgery time and median length of hospital stay was significantly shorter in Group 1 than in Group 2 (170 min vs. 240 min, p=0.001; 3 vs. 4, p=0.022; respectively). Clavien grade 3 complication rate was higher in Group 2 but was statistically insignificant. Conclusion: Our findings might reflect that previous bedside assistant experience led to an increase in self-confidence and the ability to manage troubleshooting and made it more likely for surgeons to start with more difficult cases with more challenging patients. It is recommended that novice surgeons serve as bedside assistants before moving on to consoles.

Should obesity be associated with worse urinary continence outcomes after robotic-assisted radical prostatectomy? a propensity score matching analysis

“…Despite that, surgeons involved in this study overcame their learning curve with a standardized protocol and similar methods. They were included at the robotic program after assisting cases as bedside surgeons (24), completing the training on da Vinci system, and after approval of the head of the department. Some of them have a huge previous experience in open procedures.…”

Role and Training of the Bedside Surgeon in Robotic Surgery: A Survey Among French Urologists-in-Training

“… 16 According to Cimen, prior practice as bedside surgeon let the console surgeon reach better surgical outcomes for radical prostatectomy. 17 …”

“…16 According to Cimen, prior practice as bedside surgeon let the console surgeon reach better surgical outcomes for radical prostatectomy. 17 To go into more details, Sheridan et al estimated that a surgeon should only operate from the console after 20 procedures as bedside surgeon, 11 whereas Winder et al suggested 10 procedures as threshold in their training program. 16 This is in keeping with our results, 73% of the respondents reporting that they would feel confident after 5 to 10 interventions.…”

“…Regarding conventional laparoscopy, according to 19.8% (17), the principal surgeon required residents to have previous assistant experience, whereas 36% (31) in robotic surgery.…”

Impact of bedside assistant on outcomes of robotic thyroid surgery

“…Furthermore, as the experience of bedside assistants increased, the bedside assistants became familiar with the operative setting and learned more from watching cases. [ 27 ] Cimen et al [ 28 ] indicated that previous bedside assistant experience enhanced troubleshooting skills. Xu et al [ 29 ] reported that, in addition to individual surgeon experience, team familiarity contributed to reductions in operative times.…”