title: Robot-assisted laparoscopic prostatectomy versus open: comparison of the learning curve of a single surgeon.
abstract: OBJECTIVE
  Because of the increased use of robot-assisted laparoscopic prostatectomy (RALP) for the management of localized prostate cancer, surgeons in training face the issues of developing skills in both open surgery and the robotic console. This study compares prospectively the safety and efficacy of the first 50 open radical retropubic prostatectomy (RRP) procedures and the first 50 RALP procedures, performed by the same surgeon in the same institution.
  
  
  METHODS
  The patients' baseline demographic, clinical, and oncologic parameters were prospectively recorded. The study end points included oncologic outcome, functional outcomes (at 3 months), and perioperative parameters. Complications were classified according to the modified Clavien system.
  
  
  RESULTS
  No statistically significant differences were noted between the two groups in terms of preoperative patient characteristics and oncologic parameters. The operative time and mean estimated blood loss were lower in the RALP group (P<0.001), but no statistically significant difference was noted in regard to transfusion rates (P=0.362). Mean hospital stay was lower in the RALP group (P<0.001). The minor (Clavien I+II) and major (Clavien III+IV) complication rates were comparable between the two groups. The overall positive margin (PSM) rates were 20% and 18% for RRP and RALP, respectively (P=0.799), while for pT(3) disease, the PSM rates were 26.1% and 22.2%% for RRP and RALP, respectively (P=0.53). The 3-month continence rates were 88% and 90% for RRP and RALP, respectively (P=0.749). For preoperatively potent patients, 3-month potency rates were comparable between the two groups (60.6% and 62.1% in the RRP and the RALP group, respectively, P=0.893).
  
  
  CONCLUSIONS
  The early learning curve for RALP appears safe and results in equivalent functional and oncologic outcome, when compared with the results of open surgery.
authors.affiliation: Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom. brucemed@hotmail.com
authors.forename: Prodromos
authors.initials: P
authors.lastname: Philippou
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Waine
authors.forename: Edward
authors.initials: E
authors.lastname: Rowe
mesh_terms: D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy / Q000009:adverse effects / Q000193:education*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D010820:Physicians; D011183:Postoperative Complications / Q000209:etiology; D011467:Prostate / Q000473:pathology / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects / Q000193:education* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery; D012371:Robotics / Q000193:education* / Q000379:methods*; D013997:Time Factors