title: First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons.
abstract: OBJECTIVE
  • To study the outcomes and learning curve of robotic-assisted laparoscopic radical prostatectomy (RALP) in a single centre by two surgeons.
  
  
  METHODS
  • In total, 500 consecutive patients underwent RALP between 2005 and 2009 carried out by two surgeons. Using an ethically-approved database, prospective data collection of demographic, surgical, oncological and functional outcomes (patient reported) was performed, with up to 4 years of follow-up. • The learning curves of both surgeons were analyzed and, in addition, the first 100 and last 100 patients were compared to determine the effect of surgeon experience.
  
  
  RESULTS
  • The mean age of the patients was 61.5 years and mean preoperative prostate-specific antigen was 7.0 µg/L. Clinical stages were T1 in 63.2%, T2 in 33.8% and T3 in 3.0% of patients. Median (range) operating time was 170 (63-420) min and median (range) blood loss was 200 (20-3000) mL, with significant improvements for both surgeons with increasing experience (P < 0.001 and P= 0.029, respectively). • Pathological stages were pT2 in 53.4%, pT3a in 41.6%, pT3b in 4.0% and pT4 in 0.6% of patients. Overall, the positive margin rate (PMR) was 24.0% and stage-specific rates were 16.1%, 30.4%, 55.0% and 100.0% for pT2, pT3a, pT3b and pT4 disease, respectively. In the last 50 cases performed by each surgeon, the PMRs for pT2 and pT3a disease were 8.0% and 19.1% (surgeon 1) and 12.9% and 23.5% (surgeon 2). • At 12 months of follow-up, 91.3% of patients were continent and, by 48 months of follow-up, 75% of men with preoperative potency who underwent bilateral nerve-sparing RALP were potent.
  
  
  CONCLUSIONS
  • This is the first report of two surgeons' learning curves in a single centre and shows that key learning curve outcomes continued to improve during the series, suggesting that the learning curve for RALP may be longer than has been previously suggested.
authors.affiliation: Addenbrooke's Hospital - Urology, Cambridge, UK. naomi.sharma@cancer.org.uk
authors.forename: Naomi Laura
authors.initials: NL
authors.lastname: Sharma
authors.forename: Alexandros
authors.initials: A
authors.lastname: Papadopoulos
authors.forename: Dominic
authors.initials: D
authors.lastname: Lee
authors.forename: John
authors.initials: J
authors.lastname: McLoughlin
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Vowler
authors.forename: Herve
authors.initials: H
authors.lastname: Baumert
authors.forename: Anne Y
authors.initials: AY
authors.lastname: Warren
authors.forename: Vishal
authors.initials: V
authors.lastname: Patil
authors.forename: Nimish
authors.initials: N
authors.lastname: Shah
authors.forename: David E
authors.initials: DE
authors.lastname: Neal
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D006801:Humans; D059032:Learning Curve; D008297:Male; D008611:Mentors; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000193:education* / Q000379:methods; D011471:Prostatic Neoplasms / Q000276:immunology / Q000601:surgery*; D012371:Robotics / Q000193:education*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen