Robotic Radical Prostatectomy in the Community Setting—the Learning Curve and Beyond: Initial 200 Cases

Patel, Vipul; Tully, A.S.; Holmes, R.; Lindsay, Jamie

doi:10.1097/01.ju.0000162082.12962.40

Cited by 389 publications

(279 citation statements)

References 13 publications

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“…Some advocate 25 cases and others 150 to 250 cases. 10,17,18 Finally, no objective report is available on the learning curve for laparoscopic extraperitoneal radical prostatectomy, especially after the pioneering era.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Extraperitoneal Radical Prostatectomy: Impact of the Learning Curve on Perioperative Outcomes and Margin Status

Rodríguez

Kapoor

Pow‐Sang³

2010

JSLS

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Extraperitoneal Radical Prostatectomy: Impact of the Learning Curve on Perioperative Outcomes and Margin Status

Rodríguez

Kapoor

Pow‐Sang³

2010

JSLS

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“…[14][15][16] However, anecdotally, as the technique has continued to evolve, high-volume robotic surgeons have noted that their results continue to improve even after several hundred cases. In open radical prostatectomy, the learning curve has been postulated to be around 250 cases.…”

Section: Discussionmentioning

confidence: 99%

Impact of body mass index on perioperative outcomes during the learning curve for robot assisted radical prostatectomy

Chalasani¹,

Martínez²,

Lim³

et al. 2010

CUAJ

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Introduction: Previous studies of robotic-assisted radical prostatectomy (RARP) have suggested that obesity is a risk factor for worse perioperative outcomes. We evaluated whether body mass index (BMI) adversely affected perioperative outcomes. Methods: A prospective database of 153 RARP (single surgeon) was analyzed. Obesity was defined as BMI ≥ 30 kg/m 2 ; normal BMI < 25 kg/m 2 ; and overweight as 25 to 30 kg/m 2 . Two separate analyses were performed: the first 50 cases (the initial learning curve) and the entire cohort of 153 RARP. Results: In the initial cohort of 50 cases (14 obese patients), there was no statistically significant difference with regards to operative times, port-placement times and estimated blood loss (EBL). Length of stay (LOS) was longer in the obese group (4.3 vs. 2.9 days); BMI remained an independent predictor of increased LOS on multivariate linear regression analysis (p = 0.002). There was no statistically significant difference in the postoperative outcomes of leak rates, margin rates and incisional herniae. In the entire cohort, when comparing obese patients to those with a normal BMI, there was no statistically significant difference in operative times, EBL, LOS, or immediate postoperative outcomes. However, on multivariate linear regression analysis, BMI was an independent predictor of increased operative time (p = 0.007). Conclusion: Obese patients do not have an increased risk of blood loss, positive margins or the postoperative complications of incisional hernia and leak during the learning curve. They do, however, have slightly longer operative times; we also noted an increased LOS in our first 50 cases. RésuméIntroduction : Des études antérieures sur la prostatectomie radicale assistée par robot (PRAR) ont laissé entendre que l'obésité était un facteur de risque de complications périopératoires. Nous avons évalué si l'indice de masse corporelle (IMC) affectait de façon négative les résultats de l'opération. Méthodologie : Une base de données prospective comptant 153 PRAR (effectuées par un seul chirurgien) a été analysée. On a défini l'obésité comme un IMC ≥ 30 kg/m 2 , un IMC normal étant < 25 kg/m 2 , et un IMC entre 25 et 30 kg/m 2 représentant un surplus de poids. Deux analyses distinctes ont été réalisées : les 50 premiers cas (courbe d'apprentissage initiale) et la cohorte entière des 153 patients ayant subi une PRAR. Résultats :Dans la cohorte initiale de 50 cas (dont 14 patients obèses), on n'a noté aucune différence significative sur le plan statistique en ce qui concerne la durée de l'opération, le temps requis pour installer l'accès vasculaire et la perte de sang approximative. La durée du séjour était plus longue dans le groupe des patients obèses (4,3 contre 2,9 jours), et l'IMC est demeuré un facteur indépendant de prédiction d'une durée prolongée du séjour lors de l'analyse de régression linéaire multivariée (p = 0,002). Aucune différence significative sur le plan statistique n'a été notée dans les résultats postopératoires quant aux taux de fuite, ...

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“…These difficulties and the emergence of robotic assistance that improves the precision and accuracy of anatomical dissection lead American laparoscopic urologists to develop the technique of robot-assisted LRP (RALP) [8][9][10][11]. One of the purposes of robotic assistance was to reduce the learning curve, even in laparoscopically naïve surgeons [10,12]. By contrast to the USA, the use of robots remained limited in Europe until recent years [13].…”

Section: Introductionmentioning

confidence: 99%

“…The two-dimensional vision with acquisition of different anatomical perspectives, the loss of some freedom of motion and hand-eye coordination, contribute to the steep learning curve of laparoscopy. These difficulties and the emergence of robotic assistance that improves the precision and accuracy of anatomical dissection lead American laparoscopic urologists to develop the technique of robot-assisted LRP (RALP) [8][9][10][11]. One of the purposes of robotic assistance was to reduce the learning curve, even in laparoscopically naïve surgeons [10,12].…”

Section: Introductionmentioning

confidence: 99%

Robot‐assisted extraperitoneal laparoscopic radical prostatectomy: experience in a high‐volume laparoscopy reference centre

et al. 2010

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surgeon were distributed into five groups according to the chronological order of the procedures. The mean follow-up after RALP was 18.3 months. Patient demographics, surgical data and postoperative variables were collected into a prospective database. Data were compared by chronological groups into single-surgeon cohort. RESULTSThe median operative time and blood loss were 140 min and 350 mL, respectively. The complication rate was 8.3%. Cancers were pT3-4 in 34.5%. The mean hospital stay and duration of bladder catheterization were 4.3 and 8.2 days, respectively. The rate of positive surgical margins (PSMs) was 17.2% in pT2 cancers. The recovery rate of continence was 98% at 12 months. Intraoperative time, blood loss and length of hospital stay were significantly improved after a short learning curve. The continence recovery, the rate and the length of PSM were also improved beyond the learning curve, but difference was not statistically significant. CONCLUSIONSRALP is a safe and reproducible procedure and offers a short learning curve for experienced laparoscopic surgeons. Beyond the learning curve, continued experience might also provide further improvements in terms of operative, pathological and functional results. KEYWORDSprostate cancer, radical prostatectomy, robotic assistance, learning curve Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVETo describe our current procedure of robotassisted laparoscopic radical prostatectomy (RALP), and to assess the effect of the learning curve on perioperative data, early oncological outcomes and functional results, as RALP has increasingly become a treatment option for men with localized prostate cancer.

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Robotic Radical Prostatectomy in the Community Setting—the Learning Curve and Beyond: Initial 200 Cases

Cited by 389 publications

References 13 publications

Laparoscopic Extraperitoneal Radical Prostatectomy: Impact of the Learning Curve on Perioperative Outcomes and Margin Status

Laparoscopic Extraperitoneal Radical Prostatectomy: Impact of the Learning Curve on Perioperative Outcomes and Margin Status

Impact of body mass index on perioperative outcomes during the learning curve for robot assisted radical prostatectomy

Robot‐assisted extraperitoneal laparoscopic radical prostatectomy: experience in a high‐volume laparoscopy reference centre

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