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Impact of Robotic Training on Surgical and Pathologic Outcomes During Robot-assisted Laparoscopic Radical Prostatectomy

      Objectives

      To prospectively compare outcomes during robotic prostatectomy between surgeons with formal training in either robotic prostatectomy (RALP) or laparoscopic prostatectomy (LRP).

      Methods

      A total of 286 robotic prostatectomies were performed by 12 urologists between August 2008 and March 2009 as part of a new robotic surgery program at one of the largest health maintenance organizations in the United States. Four surgeons had formal training in RALP and 8 had formal training in LRP. We prospectively compared surgical and pathologic outcomes between these 2 groups of surgeons.

      Results

      The 4 RALP surgeons performed 121 RALPs and the 8 LRP surgeons performed 165 RALPs. Patient demographics were similar between groups. The robot-naive group had significantly more clinical stage T1c than the robot-trained group (87.9% vs 74.4%, P = .003). Prostatectomy parameters were similar between the 2 groups of surgeons in terms of prostate size, Gleason score, pathologic stage, and estimated blood loss. The robot-trained surgeons had significantly lower overall positive margin rates (24% vs 34.6%, P = .05) and lower margin rates in T3 tumors (38.5% vs 61.8%, P = .07), which were approximately statistically significant. There was no difference in margin rates in T2 tumors. The robot-trained surgeons had significantly lower apical margin rates (8.3% vs 21.2%, P = .003) and lateral margin rates (1.7% vs 7.3%, P = .05). The robot-trained surgeons had 10%-15% shorter procedure times. There was no difference in complication rates.

      Conclusions

      Formal RALP training may be beneficial for surgical and pathologic outcomes of RALP compared with formal LRP training during the initial implementation of a new robotics program.
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      References

        • Menon M.
        • Shrivastava A.
        • Tewari A.
        • et al.
        Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes.
        J Urol. 2002; 168: 945-949
        • Ahlering T.E.
        • Skarecky D.
        • Lee D.
        • et al.
        Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy.
        J Urol. 2003; 170: 1738-1741
        • Bentas W.
        • Wolfram M.
        • Jones J.
        • et al.
        Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up.
        Eur Urol. 2003; 44: 175-181
        • Herrell S.D.
        • Smith Jr, J.A.
        Robotic-assisted laparoscopic prostatectomy: what is the learning curve.
        Urology. 2005; 66: 105-107
        • Patel V.R.
        • Tully A.S.
        • Holmes R.
        • et al.
        Robotic radical prostatectomy in the community setting—the learning curve and beyond: initial 200 cases.
        J Urol. 2005; 174: 269-272
      1. Thompson Healthcare Solucient Database and proprietary procedure data [on file at Intuitive Surgical].
        Thompson Healthcare, Santa Clara, CADecember 2008
        • Atug F.
        • Castle E.P.
        • Srivastav S.K.
        • et al.
        Positive surgical margins in robotic-assisted radical prostatectomy: impact of learning curve on oncologic outcomes.
        Eur Urol. 2006; 49: 866-872
        • Mikhail A.A.
        • Orvieto M.A.
        • Billatos E.S.
        • et al.
        Robotic-assisted laparoscopic prostatectomy: first 100 patients with one year of follow-up.
        Urology. 2006; 68: 1275-1279
        • Smith J.A.
        • Chan R.C.
        • Chang S.S.
        • et al.
        A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy.
        J Urol. 2007; 178: 2385-2390
        • Raman J.D.
        • Dong S.
        • Levinson A.
        • et al.
        Robotic radical prostatectomy: operative technique, outcomes and learning curve.
        JSLS. 2007; 11: 1-7
        • Zorn K.C.
        • Orvieto M.A.
        • Gong E.M.
        • et al.
        Robotic radical prostatectomy learning curve of a fellowship-trained laparoscopic surgeon.
        J Endourol. 2007; 21: 441-447
        • Shah A.
        • Okotie O.T.
        • Zhao L.
        • et al.
        Pathologic outcomes during the learning curve for robotic-assisted laparoscopic radical prostatectomy.
        Int Braz J Urol. 2008; 34: 159-163
        • White M.A.
        • De Haan A.P.
        • Stephens D.D.
        • et al.
        Comparative analysis of surgical margins between radical retropubic prostatectomy and RALP: are patients sacrificed during the initiation of robotics program?.
        Urology. 2009; 73: 567-571
        • O'Malley P.J.
        • van Appledorn S.
        • Bouchier-Hayes D.M.
        • et al.
        Robotic radical prostatectomy in Australia: initial experience.
        World J Urol. 2006; 24: 165-170
        • Sahabudin R.M.
        • Arni T.
        • Ashani N.
        • et al.
        Development of robotic program: an Asian experience.
        World J Urol. 2006; 24: 161-164
        • Mayer E.K.
        • Winkler M.H.
        • Aggarwal R.
        • et al.
        Robotic prostatectomy: the first UK experience.
        Int J Med Robotics Comput Assist Surg. 2006; 2: 321-328
        • Mottrie A.
        • van Migem P.
        • de Naeyer G.
        • et al.
        Robotic-assisted laparoscopic radical prostatectomy: oncologic and functional results of 184 cases.
        Eur Urol. 2007; 52: 746-751
        • Chin J.L.
        • Luke P.P.
        • Paulter S.E.
        Initial experience with robotic-assisted laparoscopic radical prostatectomy in the Canadian health care system.
        Cancer Urol Assoc J. 2007; 1: 97-101
        • Artibani W.
        • Fracalanza S.
        • Cavalleri S.
        • et al.
        Learning curve and preliminary experience with da Vinci-assisted laparoscopic radical prostatectomy.
        Urol Int. 2007; 80: 237-244
        • Wu S.T.
        • Tsui K.H.
        • Tang S.H.
        • et al.
        Laparoscopic radical prostatectomy: initial experience of robotic surgery in Taiwan.
        Anticancer Res. 2008; 28: 1989-1992
        • Jaffe J.
        • Castellucci S.
        • Cathelineau X.
        • et al.
        Robot-assisted laparoscopic prostatectomy: a single-institution's learning curve.
        Urology. 2009; 73: 127-133
      2. Hollander JB, Ibrahim IA, Petzel K. Quality assurance in robotic prostatectomy at a multi-user community hospital. In: AUA 2008 Annual Meeting; Orlando, FL; May 17-22, 2008. Abstract 1770.

        • Ficarra V.
        • Novara G.
        • Artibani W.
        • et al.
        Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies.
        Eur Urol. 2009; 55: 1037-1063
        • Guru K.A.
        • Perlmutter A.E.
        • Sheldon M.J.
        • et al.
        Apical margins after robot-assisted radical prostatectomy: does technique matter?.
        J Endourol. 2009; 23: 123-127

      Linked Article

      • Editorial Comment
        UrologyVol. 76Issue 2
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          The authors present an interesting report on the adoption of robotic prostatectomy within a single center. Not surprisingly, the data suggest that surgeons formally trained with the procedure may have improved outcomes with respect to several important parameters, including positive surgical margins (24% vs 35%) and operative time (205 minutes vs 229 minutes). Given the rapid proliferation for training the robotic technique in the United States, these findings provide relevant information regarding the early surgical experience and implications of training urologists in practice.
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