title: Robotic-assisted laparoscopic radical prostatectomy: learning curve of first 100 cases.
abstract: OBJECTIVE
  Robotic-assisted laparoscopic radical prostatectomy (RALP) is gaining popularity for treating localized prostate cancer. We aimed to analyze the learning curve of a single surgeon using RALP in Taiwan.
  
  
  METHODS
  Medical records of 100 consecutive patients who underwent RALP were retrospectively reviewed. Preoperative, perioperative and postoperative parameters between patients in the first 30 cases (Group I), the second 30 cases (Group II) and cases 61-100 (Group III) undergoing RALP were analyzed.
  
  
  RESULTS
  Console time was shorter and blood loss was reduced in Groups II and III compared with Group I. Significant differences were found in vesicourethral anastomosis time (46.38 min for Group I vs 31.0 min for Group II vs 27 min for Group III, P < 0.01). Postoperative stay became statistically significantly shorter, from 7.33 days for Group I to 3.93 days for Group II to 3.0 days for Group III. Positive surgical margin of pT2 was reduced (13.3% for Group I, 7.1% for Group II and 0% for Group III) but not of pT3 (86.7% for Group I, 75% for Group II and 62.9% for Group III). Continence rate at 3 months was higher in Groups II (95%) and III (96.6%) than in Group 1 (76.7%, P < 0.05).
  
  
  CONCLUSIONS
  For every 30 cases of RALP, vesicourethral anastomosis time and postoperative stay were significantly shorter. However, the incidence of surgical margin in pT3 prostate cancer was not significantly reduced. A learning curve of more than 100 cases is required to decrease the positive surgical margin in pT3 tumors.
authors.affiliation: Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan. ycou@vghtc.gov.tw
authors.forename: Yen Chuan
authors.initials: YC
authors.lastname: Ou
authors.forename: Chi Rei
authors.initials: CR
authors.lastname: Yang
authors.forename: John
authors.initials: J
authors.lastname: Wang
authors.forename: Chen Li
authors.initials: CL
authors.lastname: Cheng
authors.forename: Vipul R
authors.initials: VR
authors.lastname: Patel
mesh_terms: D000368:Aged; D002983:Clinical Competence; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000193:education* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics