Learning Curve Assessment of Robot-Assisted Radical Prostatectomy Compared with Open-Surgery Controls from the Premier Perspective Database

Abstract

Introduction: The primary aims of this study were to assess the learning curve effect of robot-assisted radical prostatectomy (RARP) in a large administrative database consisting of multiple U.S. hospitals and surgeons, and to compare the results of RARP with open radical prostatectomy (ORP) from the same settings. Results: The mean surgery time was longer for RARP (4.4 hours, standard deviation [SD] 1.7) compared with ORP (3.4 hours, SD 1.5) in the same hospitals ( p < 0.0001). Inpatient stay was shorter for RARP (2.2 days, SD 1.9) compared with ORP (3.2 days, SD 2.7) in the same hospitals ( p < 0.0001). The overall complications were less for RARP (10.6%) compared with ORP (15.8%) in the same hospitals, as were transfusion rates. ORP results in hospitals without a robot were not better than ORP with a robot, and pretreatment co-morbidity profiles were similar in all cohorts. Trending of results by year of procedure showed no differences in the three cohorts, but trending of RARP results by surgeon experience showed improvements in surgery time, hospital stay, conversion rates, and complication rates. Conclusions: During the initial 7 years of RARP development, outcomes showed decreased hospital stay, complications, and transfusion rates. Learning curve trends for RARP were evident for these endpoints when grouped by surgeon experience, but not by year of surgery.

da Vinci and Open Radical Prostatectomy: Comparison of Clinical Outcomes and Analysis of Insurance Costs

“…It is known from the literature that robotic surgery requires a certain learning curve and clinical success correlates with case numbers [35]. In this study, the number of surgeons performing open and robotic-assisted prostatectomy differed, while the three surgeons of the robotic-cohort were experienced both in open and robotic-assisted prostatectomy.…”

SAGES TAVAC safety and effectiveness analysis: da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA)

“…In certain disciplines, most notably urology and gynecology (prostatectomy made up 31 % and hysterectomy 41 % of all da Vinci Ò procedures in 2011), robotic surgical systems have enabled increased adoption of minimally invasive techniques by surgeons and a move away from open surgery. When compared with open prostatectomy, minimally invasive robotic prostatectomy has been demonstrated to be associated with better urinary continence and erectile function recovery, lower rates of positive surgical margins, and better perioperative outcomes [5][6][7]. However, when an established laparoscopic approach to an operation exists, the benefits of robotic surgery when compared with laparoscopy have not been demonstrated to be superior [8,9].…”

Utilization and Timing of Blood Transfusions Following Open and Robot Assisted Radical Prostatectomy

“…[15] Similarly, in a study examining 27,348 RARP performed by 744 surgeons using an administrative inpatient and outpatient database (Premier Research Perspective Database), surgeons further along their learning curve showed significant improvements in surgery time, hospital stay, conversion rates, and complication rates. [15,16]. We found that the year of operation was a significant predictor of requiring a blood transfusion within the RARP group only; with patients undergoing surgery in 2009 or earlier having a significantly higher risk of needing transfusion compared to later years.…”