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Evaluating the learning curve of experienced laparoscopic surgeons in robot-assisted radical prostatectomy.
J Endourol. 2013 Jan; 27(1):80-5.JE

Abstract

BACKGROUND AND PURPOSE

Radical prostatectomy is the gold standard surgical treatment for organ-confined prostate cancer. There is no consensus on the impact of previous laparoscopic experience on the learning curve of robot-assisted laparoscopic prostatectomy (RALP). We compared the perioperative complications and early patient outcomes from our initial 100 cases of RALP with laparoscopic prostatectomy (LRP) cases performed well beyond the learning curve.

PATIENTS AND METHODS

Between July 2011 and January 2012, 110 RALP were performed by one of two surgeons, each with previous experience of more than 1000 LRP. The cases were pair matched from among the last 208 patients who had undergone LRP by the same surgeons at the same time. The clinical parameters, operative details, postoperative complications, and short-term outcomes from these patients, collected prospectively, were compared between the two groups.

RESULTS

The prostate-specific antigen (PSA) level and age of the two groups was similar. The operative time (128.4 vs 153.9 min; P=0.01) and blood loss (200 vs 254 mL; P=0.01) was significantly less for the LRP group, but the duration of catheterization was similar (5.89 vs 6.2 days). The complication rate was low. No procedures needed conversions, and no patient had a visceral injury or blood transfusion. Twenty-three patients in the LRP group and 33 patients in the RALP group had extraprostatic disease, and the positive margin rate was 14% and 19% for these respective groups. At 3 months, PSA level was undetectable in 94% of LRP and 92% RALP patients, while 56% and 65% (P=0.062) patients in these groups were using 0 to 2 pads per day.

CONCLUSIONS

The initial results of the outcome of RALP are at least at par with those of LRP and with those of previously published RALP series. This suggests the lack of a steep learning curve for experienced laparoscopic surgeons in performing RALP.

Authors+Show Affiliations

Department of Urology, University of Leipzig, Leipzig, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

22834963

Citation

Stolzenburg, Jens-Uwe, et al. "Evaluating the Learning Curve of Experienced Laparoscopic Surgeons in Robot-assisted Radical Prostatectomy." Journal of Endourology, vol. 27, no. 1, 2013, pp. 80-5.
Stolzenburg JU, Qazi HA, Holze S, et al. Evaluating the learning curve of experienced laparoscopic surgeons in robot-assisted radical prostatectomy. J Endourol. 2013;27(1):80-5.
Stolzenburg, J. U., Qazi, H. A., Holze, S., Mende, M., Nicolaus, M., Franz, T., Ho Thi, P., Dietel, A., Liatsikos, E., & Do, M. (2013). Evaluating the learning curve of experienced laparoscopic surgeons in robot-assisted radical prostatectomy. Journal of Endourology, 27(1), 80-5. https://doi.org/10.1089/end.2012.0262
Stolzenburg JU, et al. Evaluating the Learning Curve of Experienced Laparoscopic Surgeons in Robot-assisted Radical Prostatectomy. J Endourol. 2013;27(1):80-5. PubMed PMID: 22834963.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluating the learning curve of experienced laparoscopic surgeons in robot-assisted radical prostatectomy. AU - Stolzenburg,Jens-Uwe, AU - Qazi,Hasan A R, AU - Holze,Sigrun, AU - Mende,Meinhard, AU - Nicolaus,Martin, AU - Franz,Toni, AU - Ho Thi,Phuc, AU - Dietel,Anja, AU - Liatsikos,Evangelos, AU - Do,Minh, Y1 - 2012/09/18/ PY - 2012/7/28/entrez PY - 2012/7/28/pubmed PY - 2013/6/12/medline SP - 80 EP - 5 JF - Journal of endourology JO - J Endourol VL - 27 IS - 1 N2 - BACKGROUND AND PURPOSE: Radical prostatectomy is the gold standard surgical treatment for organ-confined prostate cancer. There is no consensus on the impact of previous laparoscopic experience on the learning curve of robot-assisted laparoscopic prostatectomy (RALP). We compared the perioperative complications and early patient outcomes from our initial 100 cases of RALP with laparoscopic prostatectomy (LRP) cases performed well beyond the learning curve. PATIENTS AND METHODS: Between July 2011 and January 2012, 110 RALP were performed by one of two surgeons, each with previous experience of more than 1000 LRP. The cases were pair matched from among the last 208 patients who had undergone LRP by the same surgeons at the same time. The clinical parameters, operative details, postoperative complications, and short-term outcomes from these patients, collected prospectively, were compared between the two groups. RESULTS: The prostate-specific antigen (PSA) level and age of the two groups was similar. The operative time (128.4 vs 153.9 min; P=0.01) and blood loss (200 vs 254 mL; P=0.01) was significantly less for the LRP group, but the duration of catheterization was similar (5.89 vs 6.2 days). The complication rate was low. No procedures needed conversions, and no patient had a visceral injury or blood transfusion. Twenty-three patients in the LRP group and 33 patients in the RALP group had extraprostatic disease, and the positive margin rate was 14% and 19% for these respective groups. At 3 months, PSA level was undetectable in 94% of LRP and 92% RALP patients, while 56% and 65% (P=0.062) patients in these groups were using 0 to 2 pads per day. CONCLUSIONS: The initial results of the outcome of RALP are at least at par with those of LRP and with those of previously published RALP series. This suggests the lack of a steep learning curve for experienced laparoscopic surgeons in performing RALP. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/22834963/Evaluating_the_learning_curve_of_experienced_laparoscopic_surgeons_in_robot_assisted_radical_prostatectomy_ L2 - https://www.liebertpub.com/doi/10.1089/end.2012.0262?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -