Safety and Peri-Operative Outcomes During Learning Curve of Robot-Assisted Laparoscopic Prostatectomy: A Multi-Institutional Study of Fellowship-Trained Robotic Surgeons Versus Experienced Open Radical Prostatectomy Surgeons Incorporating Robot-Assisted Laparoscopic Prostatectomy

Abstract

OE can safely incorporate RALP into practice and achieve outcomes comparable to FEL quickly. As anticipated, FEL achieve these endpoints earlier in their practice.

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

“…RARP was associated with reduced blood loss, a classic advantage of minimal invasive surgery: the pressure of the pneumoperitoneum reduces venous blood leakage, and ligation of Santorini's plexus can be done very precisely. Hospital stay did not differ, and for RARP it is long compared to other series [3,8,9,12]. This might be explained by international differences in the health systems, patient preferences and preferences of the surgeon who wants to keep a close postoperative monitoring of patients in his/her initial experience.…”

“…Many authors measure LC by operation time [3,5,6,9,12,13,14]. This is important for anesthesiological [21] and financial reasons [22], but for the patient oncological and functional outcome is more important [7,8,10,11,12,13,15]. In the series of Doumerc et al [13] and Zorn et al [12], it was reported that the LC is longer if PSM rate was used as measurement compared to operation time, and the LC became even longer if functional outcome was assessed [13].…”

“…Leroy et al [8] analyzed the effect of a fellowship in robotic surgery on LC by comparing the results of the first 30 RARP cases from fellowship-trained surgeons with those of experienced open surgeons. Oncological results of fellowship-trained surgeons were initially better than those of experienced open surgeons, showing that a fellowship indeed shortens the LC for RARP, and that this is more important than extensive ORP experience.…”

“…Robotic assistance alleviates most of these disadvantages while maintaining the advantages of minimal invasive surgery. Overlooking the current literature, the LC for RARP is shorter and varies between 12 and 290 cases [3,5,6,7,8,9,10,11,12,13,14,15] (table 1). At the moment, no standard guidelines exist for safe initiation of RARP and surgeon credentialing [16].…”

Incorporating Robot-Assisted Prostatectomy at a Veterans Affairs Hospital: Outcomes

“…Furthermore, serious adverse events in RALP are rare. Previous studies 10,17,18 claim that the learning curve needed to achieve acceptable perioperative outcomes is 12 to 40 patients. Even with small groups of patients, these previous studies were able to capture statistically significant changes in outcomes.…”