Prostatectomía radical: comparación de los resultados obtenidos durante las curvas de aprendizaje de la técnica laparoscópica pura y de la técnica asistida por robot con la prostatectomía radical retropúbica

Purpose It is not yet possible to estimate the number of cases required for a beginner to become expert in laparoscopic radical prostatectomy. We estimated the learning curve of laparoscopic radical prostatectomy for positive surgical margins compared to a published learning curve for open radical prostatectomy. Materials and Methods We reviewed records from 8,544 consecutive patients with prostate cancer treated laparoscopically by 51 surgeons at 14 academic institutions in Europe and the United States. The probability of a positive surgical margin was calculated as a function of surgeon experience with adjustment for pathological stage, Gleason score and prostate specific antigen. A second model incorporated prior experience with open radical prostatectomy and surgeon generation. Results Positive surgical margins occurred in 1,862 patients (22%). There was an apparent improvement in surgical margin rates up to a plateau at 200 to 250 surgeries. Changes in margin rates once this plateau was reached were relatively minimal relative to the CIs. The absolute risk difference for 10 vs 250 prior surgeries was 4.8% (95% CI 1.5, 8.5). Neither surgeon generation nor prior open radical prostatectomy experience was statistically significant when added to the model. The rate of decrease in positive surgical margins was more rapid in the open vs laparoscopic learning curve. Conclusions The learning curve for surgical margins after laparoscopic radical prostatectomy plateaus at approximately 200 to 250 cases. Prior open experience and surgeon generation do not improve the margin rate, suggesting that the rate is primarily a function of specifically laparoscopic training and experience.

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“…Preliminary data do suggest that robotic assistance may speed the LC. 11,12 Naturally our findings cannot be extrapolated to robotic techniques.…”

Section: Discussionmentioning

confidence: 86%

The Learning Curve for Laparoscopic Radical Prostatectomy: An International Multicenter Study

et al. 2010

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“…Finally, it must be noted that in the modern era a laparoscopic robotic approach has been favored over pure laparoscopic surgeries mainly because of its apparent reduced learning curve [27, 28], but, especially in developing countries, its high costs, availability, and the training facilities required are still major issues that are somehow difficult to surmount, particularly in limited budget situations. Therefore, apparently, there is still a role for laparoscopic radical prostatectomy in our days, and studying the learning process and identifying a proper learning curve for this procedure in low-volume centers seem necessary even in the robotics epoch.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Radical Prostatectomy: The Learning Curve of a Low Volume Surgeon

Mitre

Rocha

Duarte

et al. 2013

The Scientific World Journal

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Objective. Analyze the learning curve for laparoscopic radical prostatectomy in a low volume program. Materials and Methods. A single surgeon operated on 165 patients. Patients were consecutively divided in 3 groups of 55 patients (groups A, B, and C). An enhancement of estimated blood loss, surgery length, and presence of a positive surgical margin were all considered as a function of surgeon's experience. Results. Operative time was 267 minutes for group A, 230 minutes for group B, and 159 minutes for group C, and the operative time decreased over time, but a significant difference was present only between groups A and C (P < 0.001). Mean estimated blood loss was 328 mL, 254 mL, and 206 mL (P = 0.24). A conversion to open surgery was necessary in 4 patients in group A. Positive surgical margin rates were 29.1%, 21.8%, and 5.5% (P = 0.02). Eight patients in group A, 4 patients in group B, and one in group C had biochemical recurrence. Conclusion. Significantly less intraoperative complications were evident after the first 51 cases. All other parameters (blood loss, operative time, and positive surgical margins) significantly decreased and stabilized after 110 cases. Those outcomes were somehow similar to previous published series by high-volume centers.

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Incidencias y complicaciones en nuestras primeras 250 prostatéctomias radicales robóticas

Arias¹,

Quintanilla²,

Tamayo³

et al. 2010

Actas Urológicas Españolas

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Robotic radical prostatectomy is a safe and reproducible procedure with optimal functional and oncological results, a shorter learning curve, greater comfort and vision for surgeons, and a complication rate similar to and even better than reported for open and laparoscopic surgery series. Complications decrease with the learning curve, but surgical team experience continues to be the key factor to achieve better results.

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Prostatectomía radical: comparación de los resultados obtenidos durante las curvas de aprendizaje de la técnica laparoscópica pura y de la técnica asistida por robot con la prostatectomía radical retropúbica

Abstract: Laparoscopic radical prostatectomy requires a longer learning curve than robotic-assisted prostatectomy. Operative time in RALP procedures was comparable to RRP cases. RALP showed benefits in terms of continence and intraoperative bleeding.

Cited by 18 publications

References 22 publications

The Learning Curve for Laparoscopic Radical Prostatectomy: An International Multicenter Study

The Learning Curve for Laparoscopic Radical Prostatectomy: An International Multicenter Study

Laparoscopic Radical Prostatectomy: The Learning Curve of a Low Volume Surgeon

Incidencias y complicaciones en nuestras primeras 250 prostatéctomias radicales robóticas

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