Robot-assisted radical prostatectomy: a case series of the first 100 patients -constitutional introduction and implementation on the basis of comprehensive department of minimal invasive surgery center-

Abstract

BackgroundAlthough a very small number of Japanese hospitals had been performing robotic surgery before 2011, the number now using it is increasing rapidly due to the application of health insurance to robotic surgery for prostate cancer (PCa) since April, 2012. We report our initial experience of treating 100 patients by robot-assisted radical prostatectomy (RARP) with a focus on constitutional introduction and implementation based on minimal invasive surgery center (MISC) and patient outcomes.MethodsThe MISC involved all of the hospital sections related to robotic surgery including four surgery departments, anesthesiology, operating room nurses, medical engineers. The data were prospectively collected from the first 100 consecutive patients who underwent RARP under supervision of MISC for localized PCa from October 2010 to December 2012.ResultsDuring the period of our initial 100 cases of RARP, the gynecology, respiratory and digestive surgery departments performed initial cases of 20, 33 and 23 robotic surgeries under control of MISC. Peri-operative complications in RARP appeared to be minimal with no cases of intra-operative open conversion. The positive surgical margin rate was 19% for the entire series. At the median follow-up time of 11.9 months, 91% of patients had undetectable PSA levels, and 76% of patients were not using pads. Sequential urinary functional data indicated a significant beneficial effect on lower urinary tract symptoms beyond cancer control over a period of several months. Although the pre-operative potent patient number was small, the transitions of constant potency recovery at precise time points were shown according to different nerve sparing procedures.ConclusionsThis is the first report of an initial 100 RARP cases that were implemented using the constitutional framework of an academic institution. The MISC is providing immeasurable benefits from the aspects of patient safety and education for the robotic surgical team. RARP is a safe and efficient method for achieving PCa control together with functional preservation, even during the initial trial for this procedure.

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

“…In none of our cases, as in those recently reported by another group evaluating initial RARP experience, was intraoperative open conversion required. 10 Our rate of severe complications (Clavien 3b or more) was 5.8% (9/154) in the entire series of patients and 10.7% (3/28) in the G3 patients, and these rates are similar to the severe complication rates found in previous studies. 9,11 However, two of the three patients with grade 3b complications in G3 showed severe ileus that required open revision.…”

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.…”

Anatomical dimensions using preoperative magnetic resonance imaging: Impact on the learning curve of robot‐assisted laparoscopic prostatectomy

“…Our operative technique, involving a transperitoneal approach, was carried out as previously described. 6 In principle, the indicators for RARP are the same as for open prostatectomy, and patients with clinical stage T1c−2c prostate cancer were considered candidates for the procedure. However, several clinical T3 patients underwent RARP because of other factors, such as when their PSA level or the number of positive cores from their prostate biopsies indicated the possibility of organconfined cancer.…”