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 Robotic Radical Prostatectomy (RRP) for localized prostate adenocarcinoma based on the following surgical and 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 from January 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. The mean operative time, mean estimated blood loss, positive surgical margin rate, site of positive surgical margins (apex, midgland, or base), postoperative complication rate, open conversion rate, and urinary continence 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 45 patients were included in Group 3 for a total of 105. There is significant difference in the mean operative 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 statistically significant difference in mean estimated blood loss among the 3 groups (706.9 mL, 528.2 mL and 386.3 mL, respectively; p<0.0001.) No open conversion was performed in all 105 patients and only 3 complications were noted in this study. There was no statistical significance with regards to positive surgical margin rates among the 3 groups (5.7%, 11.4% and 15.2%, respectively.) with the apex being the most common site of positive margin in this study. There is a statistically significant difference in 8-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 the management of localized and locally-advanced prostate cancer in the local setting. The learning curve of 30 cases, based on the experiences of the Urological Oncologist, is sufficient in establishing proficiency in performing the said procedure.