title: The role of a well-trained team on the early learning curve of robot-assisted laparoscopic procedures: the example of radical prostatectomy.
abstract: BACKGROUND
  The robot-assisted laparoscopic approach for radical prostatectomy (RARP) is being performed increasingly worldwide to treat localized prostate cancer (PCa). The aim of this study was to compare the learning curves of two surgeons with different surgical experiences.
  
  
  METHODS
  A prospective collection of peri-operative data was made: age, body mass index, PSA, clinical stage, biopsy Gleason score, operative time (OT), blood loss (BL), pathological stages, final Gleason scores, and complications. Patients were included, in two groups. The first group comprised the first 100 patients undergoing RARP by an expert laparoscopic surgeon. The second group of 100 patients was operated on by a junior surgeon without robotic console experience. Post-operative complications were defined according to the Clavien grading system for surgical morbidity
  
  
  RESULTS
  For groups 1 and 2 median age was 63 and 62 years, respectively; median pre-operative PSA level was 10 and 8, respectively; the median BMI was 24 and 25, respectively. The median operative time (OT) was 179 and 160 min, respectively (p > 0.05); and median blood loss was 217 and 346 ml, respectively (p = 0.04). The overall transfusion rate was 1.5% and two major complications were recorded in group 1 and four in group 2.
  
  
  CONCLUSIONS
  RARP is safe and reproducible even during the initial learning curve. Overcoming the learning curve is multifactorial and is necessarily dependent on the surgeon. However, joining a well-trained team probably affects positively the performance of the surgeon. The value of expert centers to train new surgeons to RARP needs to be evaluated.
authors.affiliation: Department of Urology of Pitié-Salpétrière Hospital, GHU Est, Assistance-Publique Hôpitaux de Paris; Faculté de Médecine Pierre et Marie Curie, University Paris VI Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lebeau
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.forename: Karim
authors.initials: K
authors.lastname: Ferhi
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Bitker
authors.forename: François
authors.initials: F
authors.lastname: Richard
authors.forename: Christophe
authors.initials: C
authors.lastname: Vaessen
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D013502:General Surgery; D006801:Humans; D010535:Laparoscopy / Q000193:education / Q000706:statistics & numerical data*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000193:education / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000193:education / Q000706:statistics & numerical data*; D016896:Treatment Outcome