World J Mens Health.  2015 Apr;33(1):30-35. 10.5534/wjmh.2015.33.1.30.

Learning Curve of Robot-Assisted Laparoscopic Radical Prostatectomy for a Single Experienced Surgeon: Comparison with Simultaneous Laparoscopic Radical Prostatectomy

• Ku JY
• Ha HK

• KMID: 2320737
• DOI: http://doi.org/10.5534/wjmh.2015.33.1.30

Abstract

PURPOSE
Despite the large number of analytical reports regarding the learning curve in the transition from open to robot-assisted radical prostatectomy (RARP), few comparative results with laparoscopic radical prostatectomy (LRP) have been reported. Thus, we evaluated operative and postoperative outcomes in RARP versus 100 simultaneously performed LRPs.
MATERIALS AND METHODS
A single surgeon had performed more than 1,000 laparoscopic operations, including 415 cases of radical nephrectomy, 85 radical cystectomies, 369 radical prostatectomies, and treatment of 212 other urological tumors, since 2009. We evaluated operative (operation time, intraoperative transfusion, complications, hospital stay, margin status, pathological stage, Gleason score) and postoperative (continence and erectile function) parameters in initial cases of RARP without tutoring compared with 100 recently performed LRPs.
RESULTS
Mean operation time and length of hospital stay for RARP and LRP were 145.5+/-43.6 minutes and 118.1+/-39.1 minutes, and 6.4+/-0.9 days and 6.6+/-1.1 days, respectively (p=0.003 and p=0.721). After 17 cases, the mean operation time for RARP was similar to LRP (less than 2 hours). Positive surgical margins in localized cancer were seen in 11.1% and 8.9% of cases in RARP and LRP, respectively (p=0.733). At postoperative 3 months, sexual intercourse was reported in 14.0% and 12.0%, and pad-free continence in 96.0% and 81.0% in patients with RARP and LRP, respectively (p=0.796 and p=0.012).
CONCLUSIONS
Previous large-volume experience of LRPs may shorten the learning curve for RARP in terms of oncological outcome. Additionally, previous experience with laparoscopy may improve the functional outcomes of RARP.

Keyword

Laparoscopy; Prostatectomy; Prostatic neoplasms; Robotics; Treatment outcome

MeSH Terms

Coitus
Cystectomy
Humans
Laparoscopy
Learning Curve*
Length of Stay
Nephrectomy
Prostatectomy*
Prostatic Neoplasms
Robotics
Treatment Outcome

Reference

1. Musch M, Roggenbuck U, Klevecka V, Loewen H, Janowski M, Davoudi Y, et al. Does changeover by an experienced open prostatic surgeon from open retropubic to robot-assisted laparoscopic prostatectomy mean a step forward or backward? ISRN Oncol. 2013; 2013:768647.

2. Choi YH, Lee JZ, Chung MK, Ha HK. Preliminary results for continence recovery after intrafascial extraperitoneal laparoscopic radical prostatectomy. Korean J Urol. 2012; 53:836–842.

3. Asimakopoulos AD, Annino F, D'Orazio A, Pereira CF, Mugnier C, Hoepffner JL, et al. Complete periprostatic anatomy preservation during robot-assisted laparoscopic radical prostatectomy (RALP): the new pubovesical complex-sparing technique. Eur Urol. 2010; 58:407–417.

4. Xylinas E, Ploussard G, Durand X, de la Taille A. Robot-assisted extraperitoneal laparoscopic radical prostatectomy: a review of the current literature. Urol Oncol. 2013; 31:288–293.

5. Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: initial short-term experience. Urology. 1997; 50:854–857.

6. Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris technique. J Urol. 2000; 163:1643–1649.

7. Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU Int. 2001; 87:408–410.

8. Menon M, Shrivastava A, Tewari A. Laparoscopic radical prostatectomy: conventional and robotic. Urology. 2005; 66:5 Suppl. 101–104.

9. Hakimi AA, Blitstein J, Feder M, Shapiro E, Ghavamian R. Direct comparison of surgical and functional outcomes of robotic-assisted versus pure laparoscopic radical prostatectomy: single-surgeon experience. Urology. 2009; 73:119–123.

10. Rozet F, Jaffe J, Braud G, Harmon J, Cathelineau X, Barret E, et al. A direct comparison of robotic assisted versus pure laparoscopic radical prostatectomy: a single institution experience. J Urol. 2007; 178:478–482.

11. Gosseine PN, Mangin P, Leclers F, Cormier L. Pure laparoscopic versus robotic-assisted laparoscopic radical prostatectomy: comparative study to assess functional urinary outcomes. Prog Urol. 2009; 19:611–617.

12. Wolanski P, Chabert C, Jones L, Mullavey T, Walsh S, Gianduzzo T. Preliminary results of robot-assisted laparoscopic radical prostatectomy (RALP) after fellowship training and experience in laparoscopic radical prostatectomy (LRP). BJU Int. 2012; 110:Suppl 4. 64–70.

13. Jaffe J, Castellucci S, Cathelineau X, Harmon J, Rozet F, Barret E, et al. Robot-assisted laparoscopic prostatectomy: a single-institutions learning curve. Urology. 2009; 73:127–133.

14. Bhandari A, McIntire L, Kaul SA, Hemal AK, Peabody JO, Menon M. Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol. 2005; 174:915–918.

15. Atug F, Castle EP, Srivastav SK, Burgess SV, Thomas R, Davis R. Positive surgical margins in robotic-assisted radical prostatectomy: impact of learning curve on oncologic outcomes. Eur Urol. 2006; 49:866–871.

16. Ou YC, Yang CR, Wang J, Cheng CL, Patel VR. Comparison of robotic-assisted versus retropubic radical prostatectomy performed by a single surgeon. Anticancer Res. 2009; 29:1637–1642.

17. Sim HG, Yip SK, Lau WK, Tan JK, Cheng CW. Early experience with robot-assisted laparoscopic radical prostatectomy. Asian J Surg. 2004; 27:321–325.

18. Weizer AZ, Ye Z, Hollingsworth JM, Dunn RL, Shah RB, Wolf JS Jr, et al. Adoption of new technology and healthcare quality: surgical margins after robotic prostatectomy. Urology. 2007; 70:96–100.