ABSTRACT
PURPOSE: To investigate the learning curve and its characteristics in our initial experiences with robotic-assisted laparoscopic radical prostatectomy (RLRP) with a new da Vinci-S surgical system. MATERIALS AND METHODS: Through inspection of the patients who underwent RLRP by a single urologic surgeon from July 2007 to May 2008, the variables related to surgery were evaluated prospectively. RESULTS: RLRP was performed in 50 patients. The patients' mean age (range) was 63 years (50-73 years), and 11 patients had a history of previous abdominal surgery. The mean total operation time was 281.6 min (190-455 min). The mean set-up time was 18.6 min (14-30 min), and the mean console time was 219.8 min (150-400 min). The mean estimated blood loss (EBL) was 375.7ml (200-800 ml). The overall margin-positive rate was 26% (13/50); it was 11.9% (5/42) for pT2 tumors and 100% (8/8) for pT3 tumors. Minor complications occurred in 5 patients. All complications were treated effectively with only conservative management. The total operation time, set-up time, console time, and EBL significantly decreased as the number of patients treated grew (Spearman's rank correlation, p<0.05; Rho=-0.49, -0.35, -0.54, -0.75, respectively). The mean total operation time, set-up time, console time, and EBL were significantly decreased in the last 35 patients who needed no transfusion (p<0.05). CONCLUSIONS: The use of robotic surgery allowed the surgeon to complete the learning curve in a relatively short time period, with low perioperative complication rates and potentially good oncologic results, as indicated by the acceptable positive surgical margin in the patients with pathologically organ-confined disease.
Subject(s)
Humans , Laparoscopy , Learning , Learning Curve , Prospective Studies , Prostatectomy , Prostatic Neoplasms , RoboticsABSTRACT
To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy (RALRP) during the learning curve, in terms of surgical, oncological and functional outcomes, we conducted a prospective survey on RALRP. From July 2007, a single surgeon performed 63 robotic prostatectomies using the same operative technique. Perioperative data, including pathological and early functional results of the patient, were collected prospectively and analyzed. Along with the accumulation of the cases, the total operative time, setup time, console time and blood loss were significantly decreased. No major complication was present in any patient. Transfusion was needed in six patients; all of them were within the initial 15 cases. The positive surgical margin rate was 9.8% (5/51) in pT2 disease. The most frequent location of positive margin in this stage was the lateral aspect (60%), but in pT3 disease multiple margins were the most frequent (41.7%). Overall, 53 (84.1%) patients had totally continent status and the median time to continence was 6.56 weeks. Among 17 patients who maintained preoperative sexual activity (Sexual Health Inventory for Men > or = 17), stage below pT2, followed up for > 6 months with minimally one side of neurovascular bundle preservation procedure, 12 (70.6%) were capable of intercourse postoperatively, and the mean time for sexual intercourse after operation was 5.7 months. In this series, robotic prostatectomy was a feasible and reproducible technique, with a short learning curve and low perioperative complication rate. Even during the initial phase of the learning curve, satisfactory results were obtained with regard to functional and oncological outcome.