Prospective evaluation of factors affecting operating time in a residency/fellowship training program incorporating robot-assisted laparoscopic prostatectomy.
OBJECTIVE
A current dilemma is how to incorporate robot assisted laparoscopic radical prostatectomy (RALP) into residency/fellowship programs while containing costs and maintaining acceptable operative times. We prospectively analyzed factors that affect the time of nine separate RALP steps performed in a residency/fellowship training program incorporating the da Vinci robot.


METHODS
A prospective evaluation of 50 consecutive RALP performed by a single surgeon while incorporating trainees was completed. RALP was divided into nine segments, and time of each segment was recorded in minutes. Who performed each portion of the procedure (resident, fellow, or attending surgeon) was also analyzed. The effects of clinical and prostate cancer characteristics were analyzed statistically to investigate associations with procedure completion times for each of the nine segments. Outcomes, including complications and urinary continence, were recorded.


RESULTS
Mean age was 58 years, and body mass index was 30 kg/m(2). Mean prostate size was 49.2 grams. Nine patients (18%) had pathologic T(3) disease, and 10 patients (20%) had positive surgical margins. Median total operative time was 276 minutes (range 245-330 min). There was no statistical association with any clinical parameter prolonging total operative time or those of the nine individual steps of the operation. Locally weighted smooth time plots demonstrate stable decreases in all segments with experience. The slowest decreases were seen in bladder neck and neurovascular bundle times. Anastomosis time fluctuated the most.


CONCLUSIONS
RALP can be incorporated successfully into a residency/fellowship training program with acceptable operative times and outcomes even while the supervising physician is on his "learning curve."
Thiel
David D
DD
Department of Urology, University of Iowa, Hospitals and Clinics, Iowa City, Iowa 52242, USA.
Francis
Paula
P
Heckman
Michael G
MG
Winfield
Howard N
HN
D000368:Aged; D005257:Fellowships and Scholarships; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000193:education*; D011471:Prostatic Neoplasms / Q000601:surgery; D012371:Robotics / Q000193:education*; D013997:Time Factors; D016896:Treatment Outcome