First 500 cases of robotic‐assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons

Abstract

were T1 in 63.2%, T2 in 33.8% and T3 in 3.0% of patients. Median (range) operating time was 170 (63-420) min and median (range) blood loss was 200 (20-3000) mL, with significant improvements for both surgeons with increasing experience ( P < 0.001 and P = 0.029, respectively).• Pathological stages were pT2 in 53.4%, pT3a in 41.6%, pT3b in 4.0% and pT4 in 0.6% of patients. Overall, the positive margin rate (PMR) was 24.0% and stage-specific rates were 16.1%, 30.4%, 55.0% and 100.0% for pT2, pT3a, pT3b and pT4 disease, respectively. In the last 50 cases performed by each surgeon, the PMRs for pT2 and pT3a disease were 8.0% and 19.1% (surgeon 1) and 12.9% and 23.5% (surgeon 2).• At 12 months of follow-up, 91.3% of patients were continent and, by 48 months of follow-up, 75% of men with preoperative potency who underwent bilateral nervesparing RALP were potent. CONCLUSION• This is the first report of two surgeons' learning curves in a single centre and shows that key learning curve outcomes continued to improve during the series, suggesting that the learning curve for RALP may be longer than has been previously suggested.

Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

“…One hundred patients were classified as having extreme OCD (YBOCS score of [32][33][34][35][36][37][38][39][40]. A similar rate of clinically significant response was achieved after AC and DBS (49% vs 52%, not significant).…”

“…39,40 Stereotactic ablative neurosurgery for psychiatric disorders has been performed for more than half a century, 25 whereas experience with DBS for OCD is just over a decade old. 30 Greater experience with ablation and the more "standardized" practice of AC may account for some of the reasons why outcomes are better for that procedure.…”

Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer.

“…Additional recent case series from UK centres performing purely laparoscopic or robotic prostatectomy reported pT3 rates of 26% and 46% respectively. 156,177 In summary, men included in our study were broadly typical of the population requiring this intervention in the UK NHS, but with a possible lower rate of pT3 disease, reflecting higher use of on-demand PSA testing in the USA and other Western European countries.…”

“…In addition, those individuals deemed to be at intermediate or high risk of early biochemical recurrence according to preoperative disease characteristics (Table 22) were allocated to undergo a concurrent pelvic lymph node dissection; the probability of this was defined from an appropriate additional literature source 177 as the information was not available from the systematic review. Adverse events during surgery could initiate two further model events.…”

“…177,179 Expert opinion deemed that all men with positive lymph nodes were assigned to further cancer treatment without the opportunity for a period of surveillance. Second, men who had two or more of the following features found on pathological examination of the removed prostate were considered for immediate further treatment: If only one of these pathological disease characteristics was present the individual entered the surveillance pathway ( Figure 17).…”