Robotic-assisted radical prostatectomy—impact of a mentorship program on oncological outcomes during the learning curve

Ryan, James; Lynch, Olwyn; Broe, M.; Swan, Niall; Moran, Dermot; McGuire, Barry B.; Mulvin, D.

doi:10.1007/s11845-021-02556-9

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…Furthermore, the exclusion of surgical margins as an outcome measure due to conflicting data necessitates further investigation to elucidate their significance in RARP outcomes [29,30]. Additionally, we want to highlight that our surgeons did not follow a pre-set mentorship program; we recognize that a mentorship program can enhance learning curves and could result in better learning curves, as shown by some studies [23,31]. Lastly, according to the new 2024 guidelines, around 16% of the patients in the study would have been selected for active surveillance instead of immediate treatment because they fall into the ISUP 1 group.…”

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

“…Notably, the study of Chang et al acknowledged the positive impact of previous laparoscopic experience on both operative time and continence rates in prostatectomies [22]. In the same direction, Ryan et al [23] introduced the importance of a mentorship program for improving the LC of RARP; they described an analysis of a single surgeon with previous laparoscopic experience with the presence of a mentor in the initial cases, highlighting the minimal surgical complications in their series.…”

Section: Discussionmentioning

confidence: 99%

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Robot-Assisted Radical Prostatectomy (RARP) Trifecta Learning Curve for Surgeons with Previous Experience in Laparoscopy

Carlos,

Dario,

Popescu

et al. 2024

Medicina

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Background and Objectives: Robot-assisted radical prostatectomy (RARP) is a complex surgery with a steep learning curve (LC). No clear evidence exists for how previous laparoscopic experience affects the RARP LC. We report the LC of three surgeons with vast experience in laparoscopy (more than 400 procedures), analyzing the results of functional and oncological outcomes under the “Trifecta” concept (defined as the achievement of continence, potency, and oncological control free of biochemical recurrence). Materials and Methods: The surgical experience of the three surgeons from September 2021 to December 2022, involving 146 RARP consecutive patients in a single institution center, was evaluated prospectively. Erectile disfunction patients were excluded. ANOVA and chi-square test were used to compare the distribution of variables between the three surgeons. LC analysis was performed using the cumulative sum control chart (CUSUM) technique to achieve trifecta. Results: The median age was 65.42 (±7.34); the clinical stage were T1c (68%) and T2a (32%); the biopsy grades were ISUP 1 (15.9%), ISUP 2 (47.98), and ≥ISUP 3 (35%). The median surgical time was 132.8 (±32.8), and the mean intraoperative bleeding was 186 cc (±115). Complications included the following: Clavien–Dindo I 8/146 (5.47%); II 9/146 (6.16%); and III 3/146 (2.05%). Positive margins were reported in 44/146 (30.13%). The PSA of 145/146 patients (99%) at 6 months was below 0.08. Early continence was achieved in 101/146 (69.17%), 6-month continence 126/146 (86%), early potency 51/146 (34.9%), and 6-month potency 65/146 (44%). Surgeons “a”, “b”, and “c” performed 50, 47, and 49 cases, respectively. After CUSUM analysis, the “Trifecta” LC peak was achieved at case 19 in surgeon “a”, 21 in surgeon “b”, and 20 in surgeon “c”. Conclusions: RARP LC to accomplish “Trifecta” can be significantly reduced in surgeons with previous experience in laparoscopy and be achieved at around 20 cases.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Robot-Assisted Radical Prostatectomy (RARP) Trifecta Learning Curve for Surgeons with Previous Experience in Laparoscopy

Carlos,

Dario,

Popescu

et al. 2024

Medicina

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“…Their results were mostly based on surgical outcomes such as operation time, blood loss and specimen radicality. [33][34][35] Regarding oncological outcomes, several studies performed after the LACC trial suggest it would be safe to continue with minimally invasive surgery when performed by experienced (high-volume) surgeons. 36,37 However, these studies do not specify how the surgeons were trained, other than one study mentioning the surgeons were fellowship-trained.…”

Section: Discussionmentioning

confidence: 99%

Introducing a novice surgeon to an experienced robotic gynaecological oncology team: an observational cohort study on the impact of a structured curriculum on outcomes of cervical cancer surgery.

Baeten

Hoogendam

Schreuder

et al. 2023

Preprint

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Objective Effect on patient outcomes when introducing a novice robotic surgeon, trained in accordance with a structured learning curriculum, to an experienced robotic surgery team. Design Observational cohort study. Setting Tertiary referral centre. Population Patients with early-stage cervical cancer who were treated with primary robot-assisted surgery between 2007 and 2019. In addition to the 165 patients included in a former analysis, we included a further 61 consecutively treated patients and divided all patients over three groups: early learning phase of 61 procedures (group 1), experienced phase of the 104 procedures thereafter (group 2), and the final 61 procedures during introduction of a novice with structured training (group 3). Methods Risk-adjusted cumulative sum (RA-CUSUM) analysis was performed and patient outcomes between groups were compared. Main Outcome Measures Surgical proficiency based on recurrence, surgical and oncological outcomes. Results Based on RA-CUSUM analysis, no learning curve effect was observed for group 3. Regarding surgical outcomes, mean operation time in group 3 was significantly shorter than group 1 ( p<0.001) and similar to group 2 ( p=0.96). Proportions of intraoperative and postoperative adverse events in group 3 were not significantly different from the experienced group (group 2). Regarding oncological outcomes, the 5-year disease-free survival, disease-specific survival, and overall survival in group 3 were not significantly different from the experienced group. Conclusions Introducing a novice robotic surgeon, who was trained in accordance with a structured learning curriculum, resulted in similar patient outcomes as by experienced surgeons suggesting novices can progress through a learning phase without compromising outcomes of cervical cancer patients.

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“…Second, many studies lack representativeness, as they typically examine the learning curves of one or a few surgeons [ 9 ]. The learning curve can vary significantly among individual surgeons due to factors such as prior training in other surgical modalities, operative experience in other procedures, and simulation or coaching, which can potentially shorten the learning curve [ 12 , 13 ]. Additionally, the frequency of performing a procedure (case cadence) may impact learning curves, an aspect not thoroughly examined in the literature.…”

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confidence: 99%

CUSUM learning curves: what they can and can’t tell us

et al. 2023

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Introduction There has been increased interest in assessing the surgeon learning curve for new skill acquisition. While there is no consensus around the best methodology, one of the most frequently used learning curve assessments in the surgical literature is the cumulative sum curve (CUSUM) of operative time. To demonstrate the limitations of this methodology, we assessed the CUSUM of console time across cohorts of surgeons with differing case acquisition rates while varying the total number of cases used to calculate the CUSUM. Methods We compared the CUSUM curves of the average console times of surgeons who completed their first 20 robotic-assisted (RAS) cases in 13, 26, 39, and 52 weeks, respectively, for their first 50 and 100 cases, respectively. This analysis was performed for prostatectomy (1094 surgeons), malignant hysterectomy (737 surgeons), and inguinal hernia (1486 surgeons). Results In all procedures, the CUSUM curve of the cohort of surgeons who completed their first 20 procedures in 13 weeks demonstrated a lower slope than cohorts of surgeons with slower case acquisition rates. The case number at which the peak of the CUSUM curve occurs uniformly increases when the total number of cases used in generation of the CUSUM chart changes from 50 to 100 cases. Conclusion The CUSUM analyses of these three procedures suggests that surgeons with fast initial case acquisition rates have less variability in their operative times over the course of their learning curve. The peak of the CUSUM curve, which is often used in surgical learning curve literature to denote “proficiency” is predictably influenced by the total number of procedures evaluated, suggesting that defining the peak as the point at which a surgeon has overcome the learning curve is subject to routine bias. The CUSUM peak, by itself, is an insufficient measure of “conquering the learning curve.”

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Robotic-assisted radical prostatectomy—impact of a mentorship program on oncological outcomes during the learning curve

Cited by 9 publications

References 20 publications

Robot-Assisted Radical Prostatectomy (RARP) Trifecta Learning Curve for Surgeons with Previous Experience in Laparoscopy

Robot-Assisted Radical Prostatectomy (RARP) Trifecta Learning Curve for Surgeons with Previous Experience in Laparoscopy

Introducing a novice surgeon to an experienced robotic gynaecological oncology team: an observational cohort study on the impact of a structured curriculum on outcomes of cervical cancer surgery.

CUSUM learning curves: what they can and can’t tell us

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