Korean J Urol.  2009 Feb;50(2):140-147.

Learning Curve with Robotic-Assisted Laparoscopic Radical Prostatectomy: A Prospective Study

Affiliations
  • 1Department of Urology, Korea University College of Medicine, Seoul, Korea. jcheon@korea.ac.kr

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.

Keyword

Prostatic neoplasms; Prostatectomy; Robotics; Laparoscopy

MeSH Terms

Humans
Laparoscopy
Learning
Learning Curve
Prospective Studies
Prostatectomy
Prostatic Neoplasms
Robotics

Figure

  • Fig. 1 Console time and estimated blood loss for each patient. These all parameters all show a statistically significant decrease with more experiences. (A) Console time (Spearman's rank correlation coefficient [Rho] -0.54, p<0.001). (B) Estimated blood loss (Spearman's rank correlation coefficient [Rho] -0.75, p<0.001). RLRP: robot assisted laparoscopic radical prostatectomy


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