title: Effect of prostate gland size on the learning curve for robot-assisted laparoscopic radical prostatectomy: does size matter initially?
abstract: OBJECTIVE
  Widespread introduction of robot-assisted laparoscopic radical prostatectomy (RALRP) has led to multiple surgeons going through the learning curve (LC). One of the recommendations for surgeons on the LC for RALRP is to choose patients with smaller glands. We evaluated our LCs to determine whether prostate size influenced intraoperative outcomes and positive surgical margin rates.
  
  
  METHODS
  Data were obtained from a prospective database for the first 154 cases of RALRP performed by a single surgeon. Patients were divided into three groups based on prostate volume (PV): <40 cc (group 1), 40 to 60 cc (group 2), or >60 cc (group 3). PV was estimated by preoperative transrectal ultrasonography (TRUS) and correlated with pathologic weight (PW). Perioperative and immediate postoperative outcomes were evaluated.
  
  
  RESULTS
  A statistically significant difference in total operative times between the groups (206 minutes vs 201 minutes vs 233 minutes for groups 1, 2, and 3, respectively) was noted. With regard to individual intraoperative steps, the bladder neck reconstruction and anastomosis time was longer in group 3. No other statistically significant differences were noted. The Pearson correlation coefficient between PV estimation by TRUS and PW was r = 0.785, and an additional analysis based on PW supports the results of our study.
  
  
  CONCLUSIONS
  Prostate size influenced total operative times and the bladder neck reconstruction and anastomosis time. Our data support the use of preoperative TRUS to estimate PV and recommendations for surgeons starting on their LC to choose glands less than 60 cc.
authors.affiliation: Division of Urology, Department of Surgery, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Martínez
authors.forename: Venu
authors.initials: V
authors.lastname: Chalasani
authors.forename: Darwin
authors.initials: D
authors.lastname: Lim
authors.forename: Linda
authors.initials: L
authors.lastname: Nott
authors.forename: Reem J
authors.initials: RJ
authors.lastname: Al-Bareeq
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Wignall
authors.forename: Larry
authors.initials: L
authors.lastname: Stitt
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Pautler
mesh_terms: D015331:Cohort Studies; D006801:Humans; D010535:Laparoscopy; D007858:Learning; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D019990:Perioperative Care; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011468:Prostatectomy / Q000193:education* / Q000379:methods*; D012007:Rectum / Q000000981:diagnostic imaging; D012371:Robotics / Q000193:education*; D013997:Time Factors; D014463:Ultrasonography