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First 500 cases of robotic‐assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons
Author(s) -
Sharma Naomi Laura,
Papadopoulos Alexandros,
Lee Dominic,
McLoughlin John,
Vowler Sarah L.,
Baumert Herve,
Warren Anne Y.,
Patil Vishal,
Shah Nimish,
Neal David E.
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09941.x
Subject(s) - prostatectomy , medicine , laparoscopic radical prostatectomy , learning curve , general surgery , robotic surgery , urology , population , surgery , prostate cancer , cancer , management , economics , environmental health
Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The recent uptake of robotic‐assisted laparoscopic radical prostatectomy by urologists has led to questions about its implementation and results, particularly with reference to the learning curve. There have been several large studies, including from the USA, but as yet, no published data from a large series in the UK. This is the first published series of robotic‐assisted laparoscopic radical prostatectomy from the UK, and provides detailed outcomes from a single centre treating patients from an unscreened population. These outcomes suggest the learning curve for robotic prostatectomy is longer than has previously been suggested and highlights the importance of a structured mentoring program. OBJECTIVE • To study the outcomes and learning curve of robotic‐assisted laparoscopic radical prostatectomy (RALP) in a single centre by two surgeons. PATIENTS AND METHODS • In total, 500 consecutive patients underwent RALP between 2005 and 2009 carried out by two surgeons. Using an ethically‐approved database, prospective data collection of demographic, surgical, oncological and functional outcomes (patient reported) was performed, with up to 4 years of follow‐up. • The learning curves of both surgeons were analyzed and, in addition, the first 100 and last 100 patients were compared to determine the effect of surgeon experience. RESULTS • The mean age of the patients was 61.5 years and mean preoperative prostate‐specific antigen was 7.0 µg/L. Clinical stages were T1 in 63.2%, T2 in 33.8% and T3 in 3.0% of patients. Median (range) operating time was 170 (63–420) min and median (range) blood loss was 200 (20–3000) mL, with significant improvements for both surgeons with increasing experience ( P < 0.001 and P = 0.029, respectively). • Pathological stages were pT2 in 53.4%, pT3a in 41.6%, pT3b in 4.0% and pT4 in 0.6% of patients. Overall, the positive margin rate (PMR) was 24.0% and stage‐specific rates were 16.1%, 30.4%, 55.0% and 100.0% for pT2, pT3a, pT3b and pT4 disease, respectively. In the last 50 cases performed by each surgeon, the PMRs for pT2 and pT3a disease were 8.0% and 19.1% (surgeon 1) and 12.9% and 23.5% (surgeon 2). • At 12 months of follow‐up, 91.3% of patients were continent and, by 48 months of follow‐up, 75% of men with preoperative potency who underwent bilateral nerve‐sparing RALP were potent. CONCLUSION • This is the first report of two surgeons’ learning curves in a single centre and shows that key learning curve outcomes continued to improve during the series, suggesting that the learning curve for RALP may be longer than has been previously suggested.