Analysis of the Learning Curve of Surgeons without Previous Experience in Laparoscopy to Perform Robot-Assisted Radical Prostatectomy

Abstract

Objective To assess the learning curve in robot-assisted radical prostatectomy (RARP) performed by surgeons without previous experience in laparoscopic prostatectomy. Materials and Methods We analyzed 119 patients submitted to RARP performed by two surgeons without previous experience in laparoscopic prostatectomy, with emphasis on the relevant outcomes such as continence, erectile function, and oncologic control with a minimum follow-up of 24 months. We used Fisher's exact test and the chi-square test to investigate the existence of a relationship between the variables and analysis of variance (ANOVA) to verify possible statistically significant differences between groups, at the 5% level. Results The patients' age varied from 41 to 72 years (mean = 61.09), with 68 (57.14%) cases having intermediate or high risk. There was a consistent decline in operative time. Of the 119 patients, 80.67% were continent 6 months after surgery and 89.07% 12 months afterward, while 35.29% were potent 6 months after surgery and 60.50% 12 months following surgery. Twelve months after surgery, the trifecta outcome rate was 51.26% and the pentafecta rate was 31.09%. There was progressive postoperative improvement and maintenance of continence and sexual potency until the last patient was operated in our sample. Conclusions Robot-assisted radical prostatectomy does not require previous experience in laparoscopic radical prostatectomy, but the learning curve is not short to achieve the plateau.

Patient-reported outcomes after robot-assisted radical prostatectomy and institutional learning curve for functional outcomes

“…First, even though we examined about 300 cases, it is unclear if a plateau was reached. The PRM rate was still higher than in other reports,[ 26 - 29 ] which suggests that the learning curve is still in the midrange of the slope. Second, an expert was defined as a surgeon with experience of more than 40 RARP cases.…”

“…Our results show the importance of establishing an educational system to shorten the RARP learning curve. [ 26 - 29 ] No LRP experience is thought to be required to perform RARP, and we did not find that a lack of experience had a negative effect. The first two surgeons had considerable experience with LRP, but the surgeons from the middle period had little or no experience.…”

First robot‐assisted radical prostatectomy in a client‐owned Bernese mountain dog with prostatic adenocarcinoma

“…The main surgeon was a surgeon experienced in robotic surgery, so it may not be appropriate to generalize our findings to surgeons during their learning curve for this procedure. However, robotic assistance has been shown to help surgeons unfamiliar with laparoscopic prostatectomy in achieving similar results with fewer case numbers 29‐31 . Finally, the high cost of the equipment required to perform the procedure may currently prevent the widespread application of robot‐assisted surgery in veterinary medicine.…”