title: Trainees do not negatively impact the institutional learning curve for robotic prostatectomy as characterized by operative time, estimated blood loss, and positive surgical margin rate.
abstract: OBJECTIVE
  We evaluated the learning curves and perioperative outcomes of an experienced laparoscopic surgeon and his trainees to assess our structured teaching program.
  
  
  METHODS
  We retrieved 383 patients undergoing robot-assisted laparoscopic prostatectomy (RALP) from our database. Trainees completed a structured teaching program and were categorized as early (days 0 to 232), mid (days 566 to 797), and late (days 825 to 1218) according to the time period in which they were working with the mentor. We compared operative times, estimated blood loss (EBL), and positive surgical margin (PSM) rates between the trainees and the mentor (Mann-Whitney and Chi-square test). Association of EBL, body mass index (BMI), and prostate weight with operative time was evaluated in multivariate linear regression analysis.
  
  
  RESULTS
  Median operative times of the early, mid, and late trainees (258, 220, and 200 minutes) significantly decreased and were similar to the corresponding senior surgeon's (254, 242, and 180 minutes). Operative times decreased with lower BMI, EBL, and prostate weight (P = 0.006, P <0.001, and P <0.001, respectively). Overall, EBL (150 mL vs. 150 mL, P = 0.215) and PSM rates (20% vs. 18.6%, P = 0.741) did not differ between the mentor and the trainees.
  
  
  CONCLUSIONS
  A structured teaching program for RALP is effective and trainees are able to adopt the increased efficiency and skills of their mentor. Lower BMI, EBL, and prostate weight were associated with shorter operative times. Trainees performing the procedure did not negatively affect EBL and positive surgical margin rate.
authors.affiliation: Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Florian R
authors.initials: FR
authors.lastname: Schroeck
authors.forename: Chiquita A Palha
authors.initials: CA
authors.lastname: de Sousa
authors.forename: Ross A
authors.initials: RA
authors.lastname: Kalman
authors.forename: Maitri S
authors.initials: MS
authors.lastname: Kalia
authors.forename: Sean A
authors.initials: SA
authors.lastname: Pierre
authors.forename: George E
authors.initials: GE
authors.lastname: Haleblian
authors.forename: Leon
authors.initials: L
authors.lastname: Sun
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
authors.forename: David M
authors.initials: DM
authors.lastname: Albala
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002983:Clinical Competence; D015331:Cohort Studies; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D008297:Male; D008611:Mentors; D008875:Middle Aged; D015397:Program Evaluation; D011468:Prostatectomy / Q000009:adverse effects / Q000193:education*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome