Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?

ABSTRACT Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience. Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates. Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups. Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP.

Manejo clínico del cáncer de próstata localizado: Guías de la Asociación americana de urología

El cáncer de próstata continúa en constante crecimiento y se espera que en unos pocos años sea la neoplasia que más muertes por cáncer cause en la población masculina. La asociación Americana de urología preocupada por esta situación y ante los avances tecnológicos- particularmente del antígeno específico de próstata y el ultrasonido - y la posibilidad de ofrecer un mejor tratamiento a los pacientes afectados por esta neoplasia, definió a través del panel de cáncer de próstata, las guías para el manejo clínico del cáncer de próstata. El panel condujo el estudio a trvés de la revisión de toda la literatura médica publicada en relación con la respuesta al tratamiento del cáncer de próstata clínicamente localizado. El objetivo fue formular recomendaciones terapéuticas basadas en los datos científicos publicados - se revisaron 12.501 artículos de los cuales se seleccionaron 1.435-. En la presente Traducción autorizada se presentan las recomendaciones del panel de cáncer de próstata con el ánimo de incorporar estas conductas a la diaria actividad profesional.