Safe Introduction of Robot-Assisted Radical Prostatectomy after a Training Program in a High-Volume Robotic Centre

Abstract

Introduction: Localized prostate cancer is increasingly treated by robot-assisted radical prostatectomy (RARP). We evaluated the introduction of RARP following a training program at a high-volume robotic center. Materials and Methods: Before starting RARP, a young urologist followed a 6-month training program. The outcome of his first 50 RARPs was compared with the last 50 open radical prostatectomies (ORPs) performed by an experienced urologist at the same institution. Tumor characteristics were similar in both groups. Median follow-up was 12 (RARP) and 31 (ORP) months (p < 0.001). Results: RARP was associated with more nerve sparing (82 vs. ORP 46%, p < 0.001), longer operation time [median 205 (range 120-310) vs. ORP 180 (85-280) min, p = 0.001], lower decline of postoperative hemoglobin [RARP -2.1 (0.1-4.5) vs. ORP -4.0 (1.0-7.0) g/dl, p < 0.001] and shorter catheter stay [6 (5-47) vs. ORP 14 (9-43) days, p < 0.001]. Complication rates were similar. Overall and pT2-positive surgical margin rate was 8 vs. 24% (p = 0.054) and 0 vs. 11.8% (p = 0.114) for RARP vs. ORP, respectively. One-year urinary continence rate was 76.7 (RARP) and 75.8% (ORP, p = 0.833). Conclusions: RARP was safely introduced after a training program in a high-volume robotic center, both surgically, oncologically and functionally.

First Report on Joint Use of a Da Vinci® Surgical System with Transfer of Surgical Know-How between Two Public Hospitals

“…Our data show that rigorous standardization of the procedure and continuous mentoring over 1 year and almost 20 RARP procedures can neutralize the learning curve for RARP with regard to oncological and functional outcomes, as already demonstrated in other centers [11]. The only significant difference between the two hospitals was, as expected, the longer operation time of the mentored staff in St. Gallen.…”

“…A large caseload is therefore a major prerequisite for a hospital to offer this type of surgery [7]. By the same token, independent of costs, a large caseload is essential for the training of surgical teams to maintain and improve oncological and functional outcomes, especially for difficult procedures such as radical prostatectomy (RP) [8,9,10,11]. …”

Patient-Reported Urinary Incontinence and Erectile Dysfunction Following Radical Prostatectomy: Results from the European Prostate Centre Innsbruck

“…Finally, our study does neither differentiate between different surgical approaches for RP (i.e., open, laparoscopic and robot-assisted) nor compare the number to patients with prostate cancer not undergoing RP or patients who are candidates for active surveillance [35]. As robot-assisted RP is proposed to improve functional outcomes in comparison with conventional RP [36,37,38], an analysis of these two subgroups would be interesting. …”

Current status of robotic training in the UK – a trainees perspective

“…Experience in a high volume centres has been associated with the subsequent formation of a safe robotic unit in terms of functional and oncological outcome. 21 Despite the positive impact on individual training for robotic fellowships its introduction can be contentious. There is a risk that the presence of robotic fellows can impact negatively upon the training for established urology SPRs.…”