Comparative investigation on clinical outcomes of robot‐assisted radical prostatectomy between experienced open prostatic surgeons and novice open surgeons in a laparoscopically naïve center with a limited caseload

Abstract

Objectives: To compare perioperative, oncological and functional outcomes of robotassisted radical prostatectomy between experienced and novice open radical prostatectomy surgeons in a laparoscopically naïve center with a limited caseload. Methods: Six surgeons carried out robot-assisted radical prostatectomy in 154 patients, which were divided into the following three groups: group 1 (n = 90), including patients operated on by a surgeon with experience in both open radical prostatectomy and robot-assisted radical prostatectomy; group 2 (n = 36), including patients operated on by two surgeons with experience in open radical prostatectomy only; and group 3 (n = 28), including patients operated on by three surgeons with limited experience in both open radical prostatectomy or robot-assisted radical prostatectomy. Results: Groups 2 and 3 did not differ significantly in their median values of external blood loss (P = 0.165) or console time (P = 0.103). Positive surgical margin rates for pT2 patients were also similar in these two groups: 21.2% (7/33) in group 2 and 22.7% (5/22) in group 3 (P = 0.894). Kaplan-Meier analysis showed that 12 months after robot-assisted radical prostatectomy the prostate-specific antigen-free rate for pT2 patients was 96.0% in group 2 and 100% in group 3, but the pad-free continence rate was just 91.0% in group 1, 88.0% in group 2 and 75.5% in group 3 (group 1 vs group 3, P = 0.037; group 2 vs group 3, P = 0.239). The major complication rate after robot-assisted radical prostatectomy was 3.3% (3/90) in group 1, 11.1% (4/36) in group 2 and 17.9% (5/28) in group 3 (group 1 vs group 3, P = 0.008; group 2 vs group 3; P = 0.441). Conclusions: Robot-assisted radical prostatectomy offers satisfactory postoperative outcomes even when carried out by surgeons with limited experience in open radical prostatectomy.

Validation of an educational program balancing surgeon training and surgical quality control during robot‐assisted radical prostatectomy

“…PSM rates in pathological 2, 3, and total were 9.3%, 47% and 22%, respectively, which was comparable with the 4–23%, 29–50% and 6.5–32%, respectively, reported in a recent study . In addition, the present oncological outcomes are better than those of a Japanese initial series in which PSM rates in pathological 2, 3, and total were 10–21%, 44–78% and 19–27%, respectively (Table S1). The present study also showed the differential pattern of PSM between a mentor and new surgeons with a mentor.…”

Editorial Comment to Validation of an educational program balancing surgeon training and surgical quality control during robot‐assisted radical prostatectomy

“…There is hence an even larger need for the outcome of the present study to be highlighted in Japan. This study will help introduce a validated curriculum for robot‐assisted radical prostatectomy for young Japanese urologists where it has now been established that a majority of the young urologists will become robotic surgeons without enough experience of open surgery, with the main aim of balancing and training new surgeons in robotic urological surgery and ensuring strict surgical quality control …”

Editorial Comment from Dr Shiroki to Comparative investigation on clinical outcomes of robot‐assisted radical prostatectomy between experienced open prostatic surgeons and novice open surgeons in a laparoscopically naïve center with a limited caseload

“…From their retrospective analysis of RARP, Sumitomo et al. described that their own series of RARP offered satisfactory peri‐ and postoperative outcomes even for surgeons with little or no ORP experience under an experienced mentor's supervision . They also pointed out the need for more training and experience for novice ORP surgeons, so they can overcome the learning curve on their first series of RARP cases.…”