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Robot-assisted laparoscopic prostatectomy versus open: comparison of the learning curve of a single surgeon.
J Endourol. 2012 Aug; 26(8):1002-8.JE

Abstract

BACKGROUND AND PURPOSE

Because of the increased use of robot-assisted laparoscopic prostatectomy (RALP) for the management of localized prostate cancer, surgeons in training face the issues of developing skills in both open surgery and the robotic console. This study compares prospectively the safety and efficacy of the first 50 open radical retropubic prostatectomy (RRP) procedures and the first 50 RALP procedures, performed by the same surgeon in the same institution.

PATIENTS AND METHODS

The patients' baseline demographic, clinical, and oncologic parameters were prospectively recorded. The study end points included oncologic outcome, functional outcomes (at 3 months), and perioperative parameters. Complications were classified according to the modified Clavien system.

RESULTS

No statistically significant differences were noted between the two groups in terms of preoperative patient characteristics and oncologic parameters. The operative time and mean estimated blood loss were lower in the RALP group (P<0.001), but no statistically significant difference was noted in regard to transfusion rates (P=0.362). Mean hospital stay was lower in the RALP group (P<0.001). The minor (Clavien I+II) and major (Clavien III+IV) complication rates were comparable between the two groups. The overall positive margin (PSM) rates were 20% and 18% for RRP and RALP, respectively (P=0.799), while for pT(3) disease, the PSM rates were 26.1% and 22.2%% for RRP and RALP, respectively (P=0.53). The 3-month continence rates were 88% and 90% for RRP and RALP, respectively (P=0.749). For preoperatively potent patients, 3-month potency rates were comparable between the two groups (60.6% and 62.1% in the RRP and the RALP group, respectively, P=0.893).

CONCLUSION

The early learning curve for RALP appears safe and results in equivalent functional and oncologic outcome, when compared with the results of open surgery.

Authors+Show Affiliations

Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom. brucemed@hotmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

22390682

Citation

Philippou, Prodromos, et al. "Robot-assisted Laparoscopic Prostatectomy Versus Open: Comparison of the Learning Curve of a Single Surgeon." Journal of Endourology, vol. 26, no. 8, 2012, pp. 1002-8.
Philippou P, Waine E, Rowe E. Robot-assisted laparoscopic prostatectomy versus open: comparison of the learning curve of a single surgeon. J Endourol. 2012;26(8):1002-8.
Philippou, P., Waine, E., & Rowe, E. (2012). Robot-assisted laparoscopic prostatectomy versus open: comparison of the learning curve of a single surgeon. Journal of Endourology, 26(8), 1002-8. https://doi.org/10.1089/end.2011.0569
Philippou P, Waine E, Rowe E. Robot-assisted Laparoscopic Prostatectomy Versus Open: Comparison of the Learning Curve of a Single Surgeon. J Endourol. 2012;26(8):1002-8. PubMed PMID: 22390682.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Robot-assisted laparoscopic prostatectomy versus open: comparison of the learning curve of a single surgeon. AU - Philippou,Prodromos, AU - Waine,Elizabeth, AU - Rowe,Edward, Y1 - 2012/04/30/ PY - 2012/3/7/entrez PY - 2012/3/7/pubmed PY - 2012/12/20/medline SP - 1002 EP - 8 JF - Journal of endourology JO - J Endourol VL - 26 IS - 8 N2 - BACKGROUND AND PURPOSE: Because of the increased use of robot-assisted laparoscopic prostatectomy (RALP) for the management of localized prostate cancer, surgeons in training face the issues of developing skills in both open surgery and the robotic console. This study compares prospectively the safety and efficacy of the first 50 open radical retropubic prostatectomy (RRP) procedures and the first 50 RALP procedures, performed by the same surgeon in the same institution. PATIENTS AND METHODS: The patients' baseline demographic, clinical, and oncologic parameters were prospectively recorded. The study end points included oncologic outcome, functional outcomes (at 3 months), and perioperative parameters. Complications were classified according to the modified Clavien system. RESULTS: No statistically significant differences were noted between the two groups in terms of preoperative patient characteristics and oncologic parameters. The operative time and mean estimated blood loss were lower in the RALP group (P<0.001), but no statistically significant difference was noted in regard to transfusion rates (P=0.362). Mean hospital stay was lower in the RALP group (P<0.001). The minor (Clavien I+II) and major (Clavien III+IV) complication rates were comparable between the two groups. The overall positive margin (PSM) rates were 20% and 18% for RRP and RALP, respectively (P=0.799), while for pT(3) disease, the PSM rates were 26.1% and 22.2%% for RRP and RALP, respectively (P=0.53). The 3-month continence rates were 88% and 90% for RRP and RALP, respectively (P=0.749). For preoperatively potent patients, 3-month potency rates were comparable between the two groups (60.6% and 62.1% in the RRP and the RALP group, respectively, P=0.893). CONCLUSION: The early learning curve for RALP appears safe and results in equivalent functional and oncologic outcome, when compared with the results of open surgery. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/22390682/Robot_assisted_laparoscopic_prostatectomy_versus_open:_comparison_of_the_learning_curve_of_a_single_surgeon_ L2 - https://www.liebertpub.com/doi/10.1089/end.2011.0569?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -