MP23-17 LACK OF AN EXPERIENCED BEDSIDE ASSISTANT MAY ADVERSELY AFFECT OUTCOMES DURING ROBOTIC PROSTATECTOMY

Abstract

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment II1 Apr 2015MP23-17 LACK OF AN EXPERIENCED BEDSIDE ASSISTANT MAY ADVERSELY AFFECT OUTCOMES DURING ROBOTIC PROSTATECTOMY Ilana Jacobs, Aaron Lay, and Jeffrey Gahan Ilana JacobsIlana Jacobs More articles by this author , Aaron LayAaron Lay More articles by this author , and Jeffrey GahanJeffrey Gahan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1260AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic prostatectomy (RALP) has become the most common surgical method to treat prostate cancer in North America. Unlike in open surgery, the operating surgeon is at the robotic console separated from his/her assistant, thereby having less influence on the assistant's actions. The assistant aids the surgeon in a variety of important ways, such as by placing surgical clips for hemostasis, maintaining visibility by clearing the surgical field of blood, retraction of tissues, and passing different instruments and sutures. We hypothesize that the experience of the bedside assistant during RALP may affect surgical outcomes. METHODS All RALP from 7/2013-9/2014 were included from a prospectively maintained database. Outcomes were stratified by bedside assistant experience: novice (resident or physician assistant) having assisted <50 cases and experienced assistants (privately contracted firm) having assisted ≥50 cases. All cases were performed by a single surgeon and the experience of the bedside assistant was randomly distributed throughout the series due to availability. Patient demographic data were recorded. Surgical outcomes included estimated blood loss (EBL), transfusion rate, and operative time. Oncologic outcomes included pathologic T stage and positive margin rate. RESULTS 110 RALP were identified. 22.7% of cases were performed with an experienced bedside assistant, and the remainder were performed with novices. Variables thought to influence the difficulty of surgery were similar between the two groups including BMI (28.0 vs. 27.0, p=0.55), pathologic T3 disease (24% vs. 12% p=0.09) and Gleason score > 7 (19% vs. 16% p=0.50). There was also no difference in pre-operative PSA (10.4 vs. 7.7 p=0.15) and race (African American vs. Caucasian p=0.92). As for outcomes, there was no difference between experienced assistants and novice assistants in terms of OR time (216 min vs. 209 min, p=0.72) or transfusion rate (4.7% vs. 0% p=0.35). However, EBL (438 mL vs. 252 mL, p=0.03) and margin rate (33.3% vs. 12% p=0.04) were both significantly different, favoring the experienced assistant. If the threshold to be classified as an experienced assistant was lowered to 25 cases, this significance was lost for EBL (p=0.08) and margin rate (p=0.06). CONCLUSIONS An experienced bedside assistant improves surgical outcomes for RALP, with less blood loss and lower positive margin rate. This suggests that having dedicated bedside assistants along with implementing a standardized curriculum and training program for assistants may maximize outcomes for robotic surgery. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e273-e274 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ilana Jacobs More articles by this author Aaron Lay More articles by this author Jeffrey Gahan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...