Safe Introduction of Robot-Assisted Radical Prostatectomy after a Training Program in a High-Volume Robotic Centre

Abstract

INTRODUCTION: Localized prostate cancer is increasingly treated by robot-assisted radical prostatectomy (RARP). We evaluated the introduction of RARP following a training program at a high-volume robotic center. MATERIALS AND METHODS: Before starting RARP, a young urologist followed a 6-month training program. The outcome of his first 50 RARPs was compared with the last 50 open radical prostatectomies (ORPs) performed by an experienced urologist at the same institution. Tumor characteristics were similar in both groups. Median follow-up was 12 (RARP) and 31 (ORP) months (p < 0.001). RESULTS: RARP was associated with more nerve sparing (82 vs. ORP 46%, p < 0.001), longer operation time [median 205 (range 120-310) vs. ORP 180 (85-280) min, p = 0.001], lower decline of postoperative hemoglobin [RARP -2.1 (0.1-4.5) vs. ORP -4.0 (1.0-7.0) g/dl, p < 0.001] and shorter catheter stay [6 (5-47) vs. ORP 14 (9-43) days, p < 0.001]. Complication rates were similar. Overall and pT2-positive surgical margin rate was 8 vs. 24% (p = 0.054) and 0 vs. 11.8% (p = 0.114) for RARP vs. ORP, respectively. One-year urinary continence rate was 76.7 (RARP) and 75.8% (ORP, p = 0.833). CONCLUSIONS: RARP was safely introduced after a training program in a high-volume robotic center, both surgically, oncologically and functionally.