title: Safety and peri-operative outcomes during learning curve of robot-assisted laparoscopic prostatectomy: a multi-institutional study of fellowship-trained robotic surgeons versus experienced open radical prostatectomy surgeons incorporating robot-assisted laparoscopic prostatectomy.
abstract: OBJECTIVE
  To analyze and compare the safety and peri-operative outcomes of fellowship-trained robotic surgeons (FEL) and experienced open surgeons (OE) incorporating robot-assisted laparoscopic prostatectomy (RALP) into practice.
  
  
  METHODS
  Multiinstitutional, prospective data were collected on the first 30 RALP performed by FEL and OE (defined as over 1000 prostatectomies) incorporating RALP into practice. Morbidity from the peri-operative course was evaluated as were operative outcomes. The second 30 cases from the OE group were evaluated to assess for improvement with experience.
  
  
  RESULTS
  There were no rectal injuries or death in either group. Blood transfusion rates did not differ between the two groups (2% vs. 3%, p = 0.65). Open conversion occurred three times in the OE group but only within the first 30 cases. In the first 30 cases FEL had statistically lower rates of positive margins (15% vs. 34%, p = 0.008) and decreased likelihood of prolonged urethral catheter leakage (5% vs. 19%, p = 0.009). The FEL group had lower rates of failure of prostate-specific antigen to nadir < 0.15 ng/mL (2% vs. 10%, p = 0.056). There were no reoperations in the FEL group but present in 2% of the OE group initially. The second 30 cases of the OE group noted a statistical improvement for all parameters with margin rates and the requirement of prolonged catheterization becoming statistically comparable to those of the FEL group.
  
  
  CONCLUSIONS
  OE can safely incorporate RALP into practice and achieve outcomes comparable to FEL quickly. As anticipated, FEL achieve these endpoints earlier in their practice.
authors.affiliation: Department of Urology, Mayo Clinic Florida, Jacksonville, Florida 32224, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Leroy
authors.forename: David D
authors.initials: DD
authors.lastname: Thiel
authors.forename: David A
authors.initials: DA
authors.lastname: Duchene
authors.forename: Alex S
authors.initials: AS
authors.lastname: Parker
authors.forename: Todd C
authors.initials: TC
authors.lastname: Igel
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wehle
authors.forename: Manilo
authors.initials: M
authors.lastname: Goetzl
authors.forename: J Brantley
authors.initials: JB
authors.lastname: Thrasher
mesh_terms: D000368:Aged; D002983:Clinical Competence; D005257:Fellowships and Scholarships; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000193:education* / Q000379:methods*; D012371:Robotics / Q000193:education*; D012449:Safety; D016896:Treatment Outcome