Does previous robot-assisted radical prostatectomy experience affect outcomes at robot-assisted radical cystectomy? Results from the International Robotic Cystectomy Consortium.
OBJECTIVE
To evaluate the effect of previous robot-assisted radical prostatectomy (RARP) case volume on the outcomes of robot-assisted radical cystectomy. Little is known regarding the effect of previous robotic surgical experience on the implementation and execution of robot-assisted radical cystectomy.


METHODS
Using the International Robotic Cystectomy Consortium database, 496 patients were identified who had undergone robot-assisted radical cystectomy by 21 surgeons at 14 institutions from 2003 to 2009. The surgeons were divided into 4 groups according to their previous RARP experience (≤ 50, 51-100, 101-150, and > 150 cases). The overall operative time, blood loss, lymph node yield, pathologic stage, and surgical margin status were compared among the 4 groups using chi-square analysis.


RESULTS
The mean operative time was 386 minutes (range 178-827). The mean estimated blood loss was 408 mL (range 25-3500). The operative time and blood loss were both significantly associated with previous RARP experience (P < .001). The mean lymph node count was 17.8 nodes (range 0-68). Lymph node yield and increased pathologic stage were significantly associated with previous RARP experience (P < .001). Finally, 34 (7.0%) of the 482 patients had a positive surgical margin. Margin status was not significantly associated with previous RARP experience (P = .089).


CONCLUSIONS
Previous RARP case volume might affect the operative time, blood loss, and lymph node yield at robot-assisted radical cystectomy. In addition, surgeons with increased RARP experience operated on patients with more advanced tumors. Previous RARP experience, however, did not appear to affect the surgical margin status.
Hayn
Matthew H
MH
Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Hellenthal
Nicholas J
NJ
Hussain
Abid
A
Andrews
Paul E
PE
Carpentier
Paul
P
Castle
Erik
E
Dasgupta
Prokar
P
Davis
Rodney
R
Thomas
Raju
R
Khan
Shamim
S
Kibel
Adam
A
Kim
Hyung
H
Manoharan
Murugesan
M
Menon
Mani
M
Mottrie
Alex
A
Ornstein
David
D
Peabody
James
J
Pruthi
Raj
R
Palou Redorta
Joan
J
Vira
Manish
M
Schanne
Francis
F
Stricker
Hans
H
Wiklund
Peter
P
Wilding
Greg
G
Guru
Khurshid A
KA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002983:Clinical Competence; D015653:Cystectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*