Does Initial Learning Curve Compromise Outcomes for Robot-Assisted Radical Cystectomy? A Critical Evaluation of the First 60 Cases While Establishing a Robotics Program

Abstract

RARC with PLND can be performed safely at a high-volume newly established robotic surgery program with an experienced team without compromising operative, postoperative, and short-term pathologic outcomes during the LC for surgeons who are experienced in ORC.

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

“…It is interesting to note that in single-institution series, Richards et al [38], Schumacher et al [39], Guru et al [59], and Pruthi et al [60] did not find higher lymph node yields with increasing sequential case numbers. However, in the IRCC, performance of lymphadenectomy was positively correlated with surgeon and institution volume but was reduced in patients with more advanced disease (pT4 stage), which may reflect operative avoidance of bulky nodal tissue.…”

Systematic Review and Cumulative Analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Cystectomy

“…Aspects of surgery influencing perioperative outcomes after robot-assisted radical cystectomy Table 3 summarizes the studies assessing the effects of particular surgical aspects on perioperative outcomes. Five papers evaluated the effect of the number of cases previously performed on perioperative outcomes [18,35,65,68,71]. Whereas Pruthi et al failed to demonstrate any significant modification of the perioperative outcomes among the first 50 cases of RARC with extracorporeal diversion [18], Hayn et al found significant improvements in both mean time for RARC (from 180 min in the first 50 cases to 136 min in the last 64 cases; p < 0.001) and lymph node yield (from 16 nodes in the first 50 cases to 24 nodes in the last 64 cases; p < 0.001) among the first 164 RARC cases performed with extracorporeal urinary diversion [71].…”

“…Whereas Pruthi et al failed to demonstrate any significant modification of the perioperative outcomes among the first 50 cases of RARC with extracorporeal diversion [18], Hayn et al found significant improvements in both mean time for RARC (from 180 min in the first 50 cases to 136 min in the last 64 cases; p < 0.001) and lymph node yield (from 16 nodes in the first 50 cases to 24 nodes in the last 64 cases; p < 0.001) among the first 164 RARC cases performed with extracorporeal urinary diversion [71]. Analyzing their first 60 cases of RARC with extracorporeal urinary diversion, Richards et al demonstrated reduction in overall complication rates from 70% in the first 20 cases to 30% in the second and third 20 cases (p = 0.013) [35].…”

“…Both papers failed to identify any significant difference in complication rates according to patient BMI. Five papers evaluated the effect of the number of cases performed on postoperative complications [18,35,65,68,71,77]. With regard to RARC with extracorporeal urinary diversion, Richards et al [35] [68,77].…”

“…Five papers evaluated the effect of the number of cases performed on postoperative complications [18,35,65,68,71,77]. With regard to RARC with extracorporeal urinary diversion, Richards et al [35] [68,77]. Finally, two studies compared postoperative complication rates for RARC with intracorporeal and extracorporeal diversion [73,74].…”