Learning curve and preliminary experience with da Vinci-assisted laparoscopic radical prostatectomy.
OBJECTIVE
To report our initial experience in the treatment of prostate cancer with robotic-assisted laparoscopic radical prostatectomy (RALP), evaluating our results in terms of learning curve, postoperative outcomes and positive surgical margins.


METHODS
From April 2005 to February 2006, a single surgeon performed 41 RALP using the da Vinci robot (Intuitive Surgical, Inc., Sunnyvale, Calif., USA). Clinical and pathological data were collected prospectively and analyzed by a researcher from outside our clinic. The main perioperative parameters assessed were the following: operative time, blood loss, transfusion rate, conversion rate, intra- and postoperative complications, hospitalization time, catheterization time, and positive surgical margin rate. To evaluate the learning curve, patients were stratified into three groups: from case 1 to 10 (group 1), from case 11 to 20 (group 2), and from case 21 to 41 (group C).


RESULTS
Median operative time was 210 min. Mean blood loss was 400 ml, with 9.8% of the patients receiving blood transfusions. Conversion to open surgery occurred in 2 cases (4.9%), while 4 postoperative complications (9.7%) were reported. Median times of hospitalization and catheterization were 7 days. Positive surgical margins were detected in 26.8% of the cases (6.9% among pT2 patients). Operative time (p < 0.001), blood loss (p = 0.02), transfusion rate (p = 0.006), and postoperative complication rates (p = 0.03) reduced along the learning curve.


CONCLUSIONS
RALP is a feasible and reproducible technique, with a short learning curve and low perioperative complication rate. Even during the initial phase of the learning curve, good results were obtained with regard to postoperative complications and oncological outcome.
Artibani
Walter
W
Department of Oncological and Surgical Sciences, Urology Clinic, Padua, Italy. walter.artibani@unipd.it
Fracalanza
Simonetta
S
Cavalleri
Stefano
S
Iafrate
Massimo
M
Aragona
Maurizio
M
Novara
Giacomo
G
Gardiman
Marina
M
Ficarra
Vincenzo
V
D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000193:education* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics / Q000193:education*