593 SHOULD EXPERIENCED OPEN PROSTATIC SURGEONS CONVERT TO ROBOTIC SURGERY? THE REAL LEARNING CURVE FOR A SINGLE SURGEON OVER 3 YEARS

Article Outline

• INTRODUCTION AND OBJECTIVES
• METHODS
• RESULTS
• CONCLUSIONS
• Copyright

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INTRODUCTION AND OBJECTIVES 

To critically analyse the learning curve for a single experienced open surgeon converting to robotic surgery.

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METHODS 

From February 2006 to December 2008, 502 patients underwent retropubic prostatectomy (RRP) while concurrently 212 underwent robot-assisted laparoscopic prostatectomy (RALP) by a single urologist. The study was a prospective comparison of the baseline patient and tumour characteristics, intraoperative and postoperative parameters, histopathologic features and early urinary functional outcomes in the two groups.

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RESULTS 

The patients in both groups were similar with respect to age, pre-operative PSA level, and prostatic volume. However, there were significantly more high stage (T2b and T3) and grade (Gleason 9) tumours in the RRP group. The mean operating time was 147 min [75-330] for RRP and 192 min [119-525] for RALP (P=.0001). One hundred and ten cases were required to achieve 3-hours proficiency. Major complications were 1.8% and 0.8% for RALP and RRP respectively. The overall positive surgical margin (PSM) rate was 21.2% in RALP and 16.7% in RRP group (P=.18). PSM rates for pT2 were comparable and not statistically different (11.6% vs 10.1%, P=.74). pT3 PSM were statistically higher for RALP (40.5% vs 28.8%, P=.004). The learning curve analysis showed a plateau in the overall PSM rate after 146 cases. For pT2 and pT3 PSM rate, the learning curve flattened after 138 and 172 cases respectively. The early continence rates were comparable (P=.07) but statistically improved after 200 cases.

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CONCLUSIONS 

Our series has shown that certain components of the learning curve for an experienced open surgeon in transferring his skills to the robotic platform take different times. We suggest patient selection be guided by these milestones to maximise oncological outcomes.

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