The role of bedside assistant during robot assisted radical prostatectomy: Is more experience better? Analysis on perioperative and clinical outcomes

Abstract

Objectives: To analyze the impact of the bedside assistant’s experience during RARP. It is believed that the outcome of robotic surgery during Robot Assisted Radical Prostatectomy (RARP) for prostate cancer depends not only on the console surgeon’s experience. Materials and Methods: All consecutive RARPs from January 2017 to March 2018 were sourced from a prospectively maintained database. All cases were performed by the same surgeon. He was supported by three bedside assistants: one with bedside and console experience, one only with relevant bedside experience, one basically inexperienced. The patient’s parameters analyzed: age, Body Mass Index (BMI), previous abdominal surgery, prostate volume (by TRUS), pre-operative PSA, bioptic grading. Surgical outcomes analyzed included skin-to-skin operative time and estimated blood loss; clinical outcomes included length of hospital stay and time to catheter removal; the oncological outcome was represented by positive surgical margin rate. Results: A total of 116 RARPs were identified: 38 RARPs were performed with the console experienced bedside assistant, 38 with the experienced one, 40 with the novice one. The variables were similar between the three groups. As far as outcomes are concerned, there were no statistically significant differences between the three bedside assistants in terms of operative time, estimated blood loss, length of stay, days of catheterization, positive surgical margin rate.

Experience matters for robotic assistance: an analysis of case data

“…Another study analyzed case length for 222 assistants in urology by comparing their early and late cases, and found a modest decrease in case length with experience [19]. In contrast, three other studies in prostatectomy and nephrectomy involving a combined 636 patients showed no effect on patient outcomes or case length based on the experience of the assistant [18,20,21]. Studies of the impact of assistants in 191 robotic-assisted thyroid operations and 105 robotic-assisted Nissen fundoplications came to conflicting results [22,23].…”

“…The effect of operative assistant experience on outcomes has been widely studied in many settings, with different results by procedure, institution, and publication [3,[12][13][14][15][16][17][18][19][20][21][22][23]. Most of the existing literature on the effect of the assistant in robotic surgery is limited to robotic-assisted prostatectomy and nephrectomy.…”

Improving ergonomics for the bedside assistant in robotic colorectal surgery

“…There may be benefits for the BA related to the ability to sit down when bedside assistance is not required and less need for the shoulder to be abducted for a prolonged period when retracting from a distant port during laparoscopic colorectal surgery. Conversely, the BA may need to stand further away from the table and work with outstretched arms to avoid the projecting robot arms [ 6 ]. Ergonomic benefits of RCS for the BA include no requirement to hold the camera and availability of an instrument attached to the fourth robotic arm which can be controlled by the console surgeon for additional retraction [ 7 ].…”