Improvements in Robot-Assisted Prostatectomy: The Effect of Surgeon Experience and Technical Changes on Oncologic and Functional Outcomes

Abstract

Increased experience with robot-assisted prostatectomy resulted in improvements in oncologic and functional outcomes. Modifications to robot-assisted prostatectomy techniques may aid in this improvement but are also associated with transient worsening of outcomes during the learning curve of the new technique.

The impact of a structured intensive modular training in the learning curve of robot assisted radical prostatectomy

“…As consequence, more controversial is the impact of surgeon experience and learning curve on the prevalence of urinary incontinence after RALP (10). Samadi et al reported a significant increase of the continence rate after 500 cases (28); conversely excellent results were also reported in several clinical series including 100-200 cases (5,22,28). Notably, no differences were found in terms of age at surgery, baseline IIEF score, CCI, and nerve sparing technique, between the four groups.…”

“…One of the main reason for the great diffusion of RALP is the short learning curve: contrarily to LRP, where the learning curve is very steep, those surgeons approaching to RALP were able to perform minimally invasive prostatectomy with optimal results even in the early phase of their learning curve, even with limited laparoscopic skills (7). Several studies estimated that few cases (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) are needed to shorten operative time, reduce the intraoperative blood loss and complications, thus rapidly achieving proficiency in RALP (8,9). However, to reach adequate functional outcomes and optimal oncological results in terms of negative surgical margins, more and more cases are needed and the learning curve is more steep for these outcomes (10).…”

Early biochemical recurrence, urinary continence and potency outcomes following robot-assisted radical prostatectomy

“…The 12 month cumulative incidence of 79.9% for using 0 pads/day in the present study thus compares favourably to international figures. Nonetheless, a learning curve for achieving optimal continence outcome seems to exist, with reported improvements after 500 [17] and even 760 cases [18].…”

“…The possible scores for the IIEF-5 range from 5 to 25. Erectile dysfunction was classified into five categories based on IIEF-5 scores: severe (5-7), moderate (8)(9)(10)(11), mild to moderate (12)(13)(14)(15)(16)(17), mild (18)(19)(20)(21) and no erectile dysfunction (22)(23)(24)(25) [11]. Self-reported ESI was recorded preoperatively and at postoperative controls using the physician's interview.…”

Radical prostatectomy: initial experience with robot-assisted laparoscopic procedures at a large university hospital

“…One explanation could be that the present analysis dealt with the first series of RALP-treated patients at this centre, whereas RRP was already an established method at the time of data collection. This possibility is highlighted by the fact that prolonged learning curves have previously been described regarding continence outcomesinRALP [19,20].Furtherdata collection is ongoing and analyses to assess both global and individual learning curves are planned. As the current study was not randomized and as continence outcomes were based on self-report, another explanation relates to patient characteristics, which cannot be controlled for in the analyses.…”