Robotic radical prostatectomy experience of a single practitioner at and beyond the learning curve

ABSTRACT

OBJECTIVE@#To determine the proficiency of a single Urological Oncologist in performing RoboticRadical Prostatectomy (RRP) for localized prostate adenocarcinoma based on the following surgicaland functional outcomes: 1) operative time, 2) estimated blood loss, 3) positive surgical margin rate,4) postoperative complication rate, 5) open conversion rate, and 6) urinary continence rate.@*MATERIALS AND METHODS@#The authors reviewed the records of a single Urological Oncologist fromJanuary 2010 to September 2017 for patients who underwent RRP for prostate adenocarcinoma.Patients were divided into 3 groups Group 1 consisted of the first 30 cases done by the surgeon,Group 2 consisted of the next set of 30 cases, and Group 3 consisted of his cases done thereafter. Themean operative time, mean estimated blood loss, positive surgical margin rate, site of positive surgicalmargins (apex, midgland, or base), postoperative complication rate, open conversion rate, and urinarycontinence rate at 4, 8, and 12 weeks post-op were compared among the 3 groups.@*RESULTS@#A total of 30 patients were included in Group 1, another 30 were included in Group 2, and 45patients were included in Group 3 for a total of 105. There is significant difference in the meanoperative times among the 3 groups with a Group 1 having a mean operative time of 302.1 minutes,170.3 minutes for Group 2, and 146.7 minutes for Group 3 (p<0.0001.) There is a statisticallysignificant difference in mean estimated blood loss among the 3 groups (706.9 mL, 528.2 mL and386.3 mL, respectively; p<0.0001.) No open conversion was performed in all 105 patients and only3 complications were noted in this study. There was no statistical significance with regards to positivesurgical margin rates among the 3 groups (5.7%, 11.4% and 15.2%, respectively.) with the apex beingthe most common site of positive margin in this study. There is a statistically significant difference in8-week urinary continence rate among the 3 groups (12.4%, 20% and 36.2%, respectively; p=0.005).@*CONCLUSION@#Robotic Radical Prostatectomy is quickly becoming a feasible and safe option in themanagement of localized and locally-advanced prostate cancer in the local setting. The learningcurve of 30 cases, based on the experiences of the Urological Oncologist, is sufficient in establishingproficiency in performing the said procedure.