2028 ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY: A LONGER LEARNING CURVE IN A LOW VOLUME PRACTICE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized X1 Apr 20102028 ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY: A LONGER LEARNING CURVE IN A LOW VOLUME PRACTICE Daniel J. Linn and James A. Brown Daniel J. LinnDaniel J. Linn More articles by this author and James A. BrownJames A. Brown More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2074AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic-assisted laparoscopic prostatectomy (RALP) has gained significant popularity in recent years. High volume surgeons have reported the initial learning curve to be as few as 12 cases. Outcomes of open radical retropubic prostatectomy have been reported to correlate with surgical volume. We herein evaluate the initial experience and learning curve of a surgeon initiating a low volume (<2 case/month) RALP practice. METHODS After a 3-month robotic mini-fellowship sabbatical in 2004, a single surgeon (JAB) performed 21 RALP procedures over 16 months between June of 2008 and October of 2009 (average 1.3/ month). Eight different assistants were utilized- one faculty, six residents and one physician's assistant. Patient records were retrospectively reviewed to report patient characteristics, operative details and outcomes. RESULTS Median patient age, BMI and preoperative PSA were 56 (40-72) years, 27.1 (19.3-38) and 5.2 (3.1-13.1) ng/dl respectively. Median blood loss and total operative times were 200 (50-600) mL and 426 (319-732) minutes. Mean operative time was 473 minutes for the first 10 procedures and 421 minutes for the subsequent 11. Median hospital stay and postoperative follow-up was 2 (1-7) days and 6 (1-14) months. Seven patients (33%) underwent bilateral pelvic lymph node dissection (BPLND) and there were no open conversions. Twenty underwent bilateral and one unilateral neurovascular bundle sparing. One patient (5%) received a blood transfusion. Twenty (95%) were pathologic stage T2 and 1 (5%) was pathologic stage T3. One, 10, 7 and 3 specimens were Gleason sum 5, 6, 7, and ≥8 respectively. Eight (38%) had positive surgical margins. Seven patients (33%) had complications and 2 (10%) had more than one complication. Of ten patients who are 9 months or more post RALP, 5 (50%) are pad-free continent, 8 (80%) use one pad or less per day, and 3 of 9 previously potent patients (33%) remain so with or without phosphodiesterase 5 inhibitors. CONCLUSIONS RALP is a challenging procedure to learn. Urologists with a low volume (<2 case/month) practice (and/or utilizing varying assistants) may expect a greater than 20 case learning curve. Augusta, GA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e787 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel J. Linn More articles by this author James A. Brown More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...