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A Critical Analysis of the Learning Curve and Postlearning Curve Outcomes of Two Experience- and Volume-Matched Surgeons for Laparoscopic and Robot-Assisted Radical Prostatectomy.
J Endourol. 2015 Aug; 29(8):939-47.JE

Abstract

BACKGROUND AND PURPOSE

There remains equipoise with regard to whether laparoscopic radical prostatectomy (LRP) or robot-assisted radical prostatectomy (RARP) has any benefit over the other. Despite this, there is a trend for the increasing adoption of RARP at great cost to health services across the world. The aim was to critically analyze the learning curve and outcomes for LRP and RARP for two experience- and volume-matched surgeons who have completed the learning curve for LRP and RARP.

PATIENTS AND METHODS

Two experience- and volume-matched LRP and RARP surgeons who have completed the learning curve were compared with respect to their learning curve and outcomes for RARP and LRP. There were 531 RARP and 550 LRPs analyzed from April 2003 until January 2012 at two relatively high-volume United Kingdom centers. Outcome measures included operative time, blood loss, complication rate (Clavien-Dindo grade III), positive surgical margin (PSM) rate, and early continence rate.

RESULTS

Learning curves for blood loss, operative times, and complication rate were similar between groups. The overall PSM rate and pT2 PSM rate learning curves were longer for RARP compared with LRP but shorter for early continence. Apical PSM showed no learning curve for RARP; however, a long learning curve for LRP and the rate was lower for RARP than for LRP (P=<0.001).

CONCLUSIONS

This study of RARP and LRP identified that both modalities had long learning curves. Despite the long learning curve for RARP, significant benefits in lower PSM rates and better early continence in comparison with LRP exist. There are benefits to patients with RARP over LRP, especially those linked to better apical dissection (apical PSM and early continence).

Authors+Show Affiliations

1 Department of Urology, Western General Hospital , NHS Lothian, Edinburgh, United Kingdom . 2 Edinburgh Urological Cancer Group, University of Edinburgh , Edinburgh, United Kingdom .1 Department of Urology, Western General Hospital , NHS Lothian, Edinburgh, United Kingdom . 2 Edinburgh Urological Cancer Group, University of Edinburgh , Edinburgh, United Kingdom .1 Department of Urology, Western General Hospital , NHS Lothian, Edinburgh, United Kingdom . 2 Edinburgh Urological Cancer Group, University of Edinburgh , Edinburgh, United Kingdom .3 Department of Urology, University of Leipzig , Leipzig, Germany .4 Department of Urology, Guy's and St. Thomas' NHS Trust , London, United Kingdom .1 Department of Urology, Western General Hospital , NHS Lothian, Edinburgh, United Kingdom . 2 Edinburgh Urological Cancer Group, University of Edinburgh , Edinburgh, United Kingdom .

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25630790

Citation

Good, Daniel W., et al. "A Critical Analysis of the Learning Curve and Postlearning Curve Outcomes of Two Experience- and Volume-Matched Surgeons for Laparoscopic and Robot-Assisted Radical Prostatectomy." Journal of Endourology, vol. 29, no. 8, 2015, pp. 939-47.
Good DW, Stewart GD, Laird A, et al. A Critical Analysis of the Learning Curve and Postlearning Curve Outcomes of Two Experience- and Volume-Matched Surgeons for Laparoscopic and Robot-Assisted Radical Prostatectomy. J Endourol. 2015;29(8):939-47.
Good, D. W., Stewart, G. D., Laird, A., Stolzenburg, J. U., Cahill, D., & McNeill, S. A. (2015). A Critical Analysis of the Learning Curve and Postlearning Curve Outcomes of Two Experience- and Volume-Matched Surgeons for Laparoscopic and Robot-Assisted Radical Prostatectomy. Journal of Endourology, 29(8), 939-47. https://doi.org/10.1089/end.2014.0810
Good DW, et al. A Critical Analysis of the Learning Curve and Postlearning Curve Outcomes of Two Experience- and Volume-Matched Surgeons for Laparoscopic and Robot-Assisted Radical Prostatectomy. J Endourol. 2015;29(8):939-47. PubMed PMID: 25630790.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Critical Analysis of the Learning Curve and Postlearning Curve Outcomes of Two Experience- and Volume-Matched Surgeons for Laparoscopic and Robot-Assisted Radical Prostatectomy. AU - Good,Daniel W, AU - Stewart,Grant D, AU - Laird,Alexander, AU - Stolzenburg,Jens-Uwe, AU - Cahill,Declan, AU - McNeill,S Alan, Y1 - 2015/02/25/ PY - 2015/1/30/entrez PY - 2015/1/30/pubmed PY - 2016/3/24/medline SP - 939 EP - 47 JF - Journal of endourology JO - J. Endourol. VL - 29 IS - 8 N2 - BACKGROUND AND PURPOSE: There remains equipoise with regard to whether laparoscopic radical prostatectomy (LRP) or robot-assisted radical prostatectomy (RARP) has any benefit over the other. Despite this, there is a trend for the increasing adoption of RARP at great cost to health services across the world. The aim was to critically analyze the learning curve and outcomes for LRP and RARP for two experience- and volume-matched surgeons who have completed the learning curve for LRP and RARP. PATIENTS AND METHODS: Two experience- and volume-matched LRP and RARP surgeons who have completed the learning curve were compared with respect to their learning curve and outcomes for RARP and LRP. There were 531 RARP and 550 LRPs analyzed from April 2003 until January 2012 at two relatively high-volume United Kingdom centers. Outcome measures included operative time, blood loss, complication rate (Clavien-Dindo grade III), positive surgical margin (PSM) rate, and early continence rate. RESULTS: Learning curves for blood loss, operative times, and complication rate were similar between groups. The overall PSM rate and pT2 PSM rate learning curves were longer for RARP compared with LRP but shorter for early continence. Apical PSM showed no learning curve for RARP; however, a long learning curve for LRP and the rate was lower for RARP than for LRP (P=<0.001). CONCLUSIONS: This study of RARP and LRP identified that both modalities had long learning curves. Despite the long learning curve for RARP, significant benefits in lower PSM rates and better early continence in comparison with LRP exist. There are benefits to patients with RARP over LRP, especially those linked to better apical dissection (apical PSM and early continence). SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/25630790/A_Critical_Analysis_of_the_Learning_Curve_and_Postlearning_Curve_Outcomes_of_Two_Experience__and_Volume_Matched_Surgeons_for_Laparoscopic_and_Robot_Assisted_Radical_Prostatectomy_ L2 - https://www.liebertpub.com/doi/full/10.1089/end.2014.0810?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -