The impact of a structured intensive modular training in the learning curve of robot assisted radical prostatectomy

Abstract

Aim: The success of Robot Assisted Laparoscopic Prostatectomy (RALP) is mainly due to his relatively short learning curve. Twenty cases are needed to reach a "4 hours-proficiency". However, to achieve optimal functional outcomes such as urinary continence and potency recovery may require more experience. We aim to report the perioperative and early functional outcomes of patients undergoing RALP, after a structured modular training program. Methods: A surgeon with no previous laparoscopic or robotic experience attained a 3 month modular training including: a) e-learning; b) assistance and training to the operating table; c) dry console training; d) step by step in vivo modular training performing 40 surgical steps in increasing difficulty, under the supervision of an experienced mentor. Demographics, intraoperative and postoperative functional outcomes were recorded after his first 120 procedures, considering four groups of 30 cases. Results: All procedures were completed successfully without conversion to open approach. Overall 19 (15%) post operative complications were observed and 84% were graded as minor (Clavien I-II). Overall operative time and console time gradually decreased during the learning curve, with statistical significance in favour of Group 4. The overall continence rate at 1 and 3 months was 74% and 87% respectively with a significant improvement in continence rate throughout the four groups (p = 0.04). Considering those patients submitted to nerve-sparing procedure we found a significant increase in potency recovery over the four groups (p = 0.04) with the higher potency recovery rate up to 80% in the last 30 cases. Conclusions: Optimal perioperative and functional outcomes have been attained since early phase of the learning curve after an intensive structured modular training and less than 100 consecutive procedures seem needed in order to achieve optimal urinary continence and erectile function recovery.KEY WORDS: Training; Robot assisted radical prostatectomy. death in men worldwide (1). Radical prostatectomy (RP) represents the standard surgical treatment for clinically localized prostate cancer (2). Traditionally this procedure was performed with a retropubic open approach retropubic radical prostatectomy (RRP) (3), with the cost of long hospitalization, the need of additional pain medication and significant blood loss. With the aim to reduce morbidity, hospitalization and to improve functional outcomes, minimally invasive approaches including laparoscopic radical prostatectomy (LRP) and robot assisted laparoscopic prostatectomy (RALP) have been increasingly adopted as alternative to open surgery. In the last two decades RALP has gained more popularity and now is a mainstay of treatment for prostate cancer, with functional and oncological outcomes comparable or even better than RRP and LRP (4-6). One of the main reason for the great diffusion of RALP is the short learning curve: contrarily to LRP, where the learning curve is very steep, those surgeons approaching to RALP were able to per...

Early outcomes of robot-assisted radical prostatectomy following completion of a structured training curriculum: a single surgeon cohort study

“…Others reported continence rates of 86-93%; however, continence definitions were less stringent and complete continence rates were not reported. 9,10 The true RARP LC is unclear, with a number of studies reporting different findings, 28 including a PSM rate plateau as early as 50 cases. 29 An individual surgeon's LC is multifactorial and influenced by technical ability and familiarity of other prostatectomy approaches.…”

“…The pT2 and pT3 PSM rates of 14.9% and 22.6%, respectively, were better than UK national averages (pT2 PSM=17.5% and pT3 PSM= 42.3%). 26 Other studies of post-ERUS RARP curriculum outcomes have reported overall PSM rates of 10–24%, 9,10 but were limited in surgeon volume (<120 cases) 9 or excluded high risk PCa. 10 We observed very low rates of ⩾3 mm/multifocal PSMs for pT2 (5.4%) and pT3 (3.2%) disease, which have the greatest impact on long-term oncological outcomes.…”

“…However, there is a paucity of information on surgeons' outcomes data from subsequent independent practice. 9,10 Here, we describe the initial independent experience of a single UK-trained surgeon with no laparoscopic and limited (<10 case) open radical prostatectomy (ORP) experience, who completed the ERUS RARP curriculum.…”

“…However, there is a paucity of information on surgeons’ outcomes data from subsequent independent practice. 9,10…”

Motion path planning of soccer training auxiliary robot based on genetic algorithm in fixed-point rotation environment

“…Moreover, the method also considers the actual motion performance of the robot while trajectory planning and obstacle avoidance (Matsuda et al 2018). The grid method is also a common method for robot path planning research, and can be combined with a variety of methods to path the robot (Schiavina et al 2018). The researchers carried out a deeper planning on the grid method based on the grid method of the robot motion space, and finally successfully completed the path planning for the soccer robot (Belbachir et al 2018).…”