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Does Previous Robot-assisted Radical Prostatectomy Experience Affect Outcomes at Robot-assisted Radical Cystectomy? Results from the International Robotic Cystectomy Consortium

      Objectives

      To evaluate the effect of previous robot-assisted radical prostatectomy (RARP) case volume on the outcomes of robot-assisted radical cystectomy. Little is known regarding the effect of previous robotic surgical experience on the implementation and execution of robot-assisted radical cystectomy.

      Methods

      Using the International Robotic Cystectomy Consortium database, 496 patients were identified who had undergone robot-assisted radical cystectomy by 21 surgeons at 14 institutions from 2003 to 2009. The surgeons were divided into 4 groups according to their previous RARP experience (≤50, 51-100, 101-150, and >150 cases). The overall operative time, blood loss, lymph node yield, pathologic stage, and surgical margin status were compared among the 4 groups using chi-square analysis.

      Results

      The mean operative time was 386 minutes (range 178-827). The mean estimated blood loss was 408 mL (range 25-3500). The operative time and blood loss were both significantly associated with previous RARP experience (P < .001). The mean lymph node count was 17.8 nodes (range 0-68). Lymph node yield and increased pathologic stage were significantly associated with previous RARP experience (P < .001). Finally, 34 (7.0%) of the 482 patients had a positive surgical margin. Margin status was not significantly associated with previous RARP experience (P = .089).

      Conclusions

      Previous RARP case volume might affect the operative time, blood loss, and lymph node yield at robot-assisted radical cystectomy. In addition, surgeons with increased RARP experience operated on patients with more advanced tumors. Previous RARP experience, however, did not appear to affect the surgical margin status.
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      References

        • Portis A.J.
        • Yan Y.
        • Landman J.
        • et al.
        Long-term followup after laparoscopic radical nephrectomy.
        J Urol. 2002; 167: 1257-1262
        • Badani K.K.
        • Kaul S.
        • Menon M.
        Evolution of robotic radical prostatectomy: assessment after 2766 procedures.
        Cancer. 2007; 110: 1951-1958
        • Miller J.
        • Smith A.
        • Kouba E.
        • et al.
        Prospective evaluation of short-term impact and recovery of health related quality of life in men undergoing robotic assisted laparoscopic radical prostatectomy versus open radical prostatectomy.
        J Urol. 2007; 178: 854-859
        • Wood D.P.
        • Schulte R.
        • Dunn R.L.
        • et al.
        Short-term health outcome differences between robotic and conventional radical prostatectomy.
        Urology. 2007; 70: 945-949
        • Herrell S.D.
        • Smith Jr, J.A.
        Robotic-assisted laparoscopic prostatectomy: what is the learning curve?.
        Urology. 2005; 66: 105-107
        • 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
        • 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
        • Wang G.J.
        • Barocas D.A.
        • Raman J.D.
        • et al.
        Robotic vs open radical cystectomy: prospective comparison of perioperative outcomes and pathological measures of early oncological efficacy.
        BJU Int. 2008; 101: 89-93
        • Pruthi R.S.
        • Wallen E.M.
        Is robotic radical cystectomy an appropriate treatment for bladder cancer?.
        Urology. 2008; 72: 617-622
        • Guru K.A.
        • Kim H.L.
        • Piacente P.M.
        • et al.
        Robot-assisted radical cystectomy and pelvic lymph node dissection: initial experience at Roswell Park Cancer Institute.
        Urology. 2007; 69: 469-474
        • Pruthi R.S.
        • Smith A.
        • Wallen E.M.
        Evaluating the learning curve for robot-assisted laparoscopic radical cystectomy.
        J Endourol. 2008; 22: 2469-2474
        • Guru K.A.
        • Perlmutter A.E.
        • Butt Z.M.
        • et al.
        The learning curve for robot-assisted radical cystectomy.
        JSLS. 2009; 13: 509-514
        • 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
        • Vickers A.J.
        • Bianco F.J.
        • Serio A.M.
        • et al.
        The surgical learning curve for prostate cancer control after radical prostatectomy.
        J Natl Cancer Inst. 2007; 99: 1171-1177
        • Dotan Z.A.
        • Kavanagh K.
        • Yossepowitch O.
        • et al.
        Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival.
        J Urol. 2007; 178: 2308-2313
        • Hadjizacharia P.
        • Stein J.P.
        • Cai J.
        • et al.
        The impact of positive soft tissue surgical margins following radical cystectomy for high-grade, invasive bladder cancer.
        World J Urol. 2009; 27: 33-38
        • Hellenthal N.J.
        • Ramirez M.L.
        • Evans C.P.
        • et al.
        Trends in pelvic lymphadenectomy at the time of radical cystectomy: 1988-2004.
        J Urol. 2009; 181: 2490-2495