Pathologic outcomes during the learning curve for robotic-assisted laparoscopic radical prostatectomy

Abstract

Objective: We report our initial experience with 62 patients undergoing robotic-assisted laparoscopic prostatectomy (RALP), focusing on the primary parameter of positive surgical margins. The authors demonstrate that excellent oncologic outcomes can be attained with a less steep learning curve than previously hypothesized. Materials and Methods:The first 62 patients undergoing RALP by a single physician (DPD) at our institution between November 2005 and August 2007 were retrospectively assessed. Surgical pathology records were reviewed for Gleason score, pathologic tumor stage, nodal status, location of prostate cancer within the specimen, extracapsular extension, surgical margin status, presence of perineural invasion, tumor volume, and weight of the surgical specimen. Margin status was determined using surgical specimens only, and not intraoperative frozen sections. All cases in this series were completed using the four-arm da Vinci Robotic System (Intuitive Surgical, Sunnyvale, California). Results: Sixty-one patients had prostate cancer on their final surgical pathology specimens. Pathologic stage T2 and stage T3 patients were 88.7% and 9.7% of all cases, respectively. The pathologic Gleason score was 7 or greater in 62.3%. Our overall positive surgical margin rate was 3.3%. Patients with pathologic T2 and T3 disease had a positive surgical margin rate of 1.8% and 16.7%, respectively. Conclusions: Our study suggests that RALP can have equal if not better pathologic outcomes compared to open radical prostatectomy even during the initial series of cases. We argue that the learning curve for RALP is shorter than previously thought with respect to oncologic outcomes, and concerns asserting that lack of tactile feedback leads to poor oncologic outcomes are unfounded.

Biochemical recurrence after radical prostatectomy: is the disease or the surgeon to blame?

“…Felix et al compared the results of one surgeon with the highest number of RP operations with other 10 surgeons and found that rates of PSA recurrence and PSM of the surgeon with the highest number of operations were significantly lower (15). Similar results were obtained in other studies (16)(17)(18)(19). In the present study, when the results of the surgeon with the highest number of operations (188 cases) were compared to the remaining 9 surgeons, the PSM rates were observed to be consistent with the literature.…”

Review of surgical robotics user interface: what is the best way to control robotic surgery?

“…The second issue not addressed by the da Vinci system is the lack of haptic feedback. Shah et al [4] showed that the lack of haptics does not seem to affect surgical margin rates in robotic-assisted laparoscopic prostatectomy (RALP). This is largely due to its improved three-dimensional visualization system that allows for better representation of the tissue being manipulated.…”

Evolving Role of Simulators and Training in Robotic Urological Surgery

“…In a study looking at the pathologic outcomes during the learning curve for robotic-assisted laparoscopic radical prostatectomy, Shah et al reported their initial experience with 62 patients undergoing robotic-assisted laparoscopic prostatectomy (RALP), focusing on the primary parameter of positive surgical margins [19]. Their study seemed to suggest that RALP could have equal if not better pathologic outcomes compared to open radical prostatectomy even during the initial series of cases.…”