title: Preliminary results of robot-assisted laparoscopic radical prostatectomy (RALP) after fellowship training and experience in laparoscopic radical prostatectomy (LRP).
abstract: OBJECTIVE
  • To ascertain whether prior experience in laparoscopic radical prostatectomy (LRP) shortens the 'learning curve' and therefore improves early patient outcomes when transitioning to robot-assisted laparoscopic RP (RALP).
  
  
  METHODS
  • Retrospective analysis of prospectively collected data of the most recent 87 cases of LRP compared with the initial 73 cases of RALP. • LRP was performed via a five-port extraperitoneal approach, while transperitoneal RALP was performed using a four-arm da Vinci S unit.
  
  
  RESULTS
  • The median operative duration for RALP (skin-to-skin, including docking time) rapidly reduced, although never exceeded 3.5 h, for each consecutive set of 10 cases. • Oncological outcomes were preserved with no cases of pT2 positive surgical margins (PSMs) in any group. pT3 PSM rates were not significantly different at 50% and 38% for LRP and RALP, respectively. • Penetrative intercourse rates at 3 months for bilateral nerve-sparing procedures in preoperatively potent patients were similar, at 50% for LRP (median Sexual Health Inventory for Men [SHIM] 17) and 48.1% for RALP (median SHIM 18). The pad-free rate at 3 months was significantly better for RALP at 59.7%, compared with 39.8% for LRP (P= 0.043). • Complications were minimal and comparable for the two groups except for a higher LRP radiological anastomotic leak rate of 16 vs 1% (P= 0.004).
  
  
  CONCLUSIONS
  • In this comparative series fellowship training and prior experience in LRP resulted in no significant RALP learning curve with regards to oncological and functional outcomes, while maintaining a low complication rate. • A short learning curve existed for operative duration but this improved rapidly and there were no prolonged cases. • Differences in early continence and radiological leaks may reflect changing from an interrupted anastomosis (LRP) to a continuous anastomosis with posterior rhabdosphincter reconstruction (RALP).
authors.affiliation: Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. philippewolanski@gmail.com
authors.forename: Philippe
authors.initials: P
authors.lastname: Wolanski
authors.forename: Charles
authors.initials: C
authors.lastname: Chabert
authors.forename: Lee
authors.initials: L
authors.lastname: Jones
authors.forename: Tarryn
authors.initials: T
authors.lastname: Mullavey
authors.forename: Sharon
authors.initials: S
authors.lastname: Walsh
authors.forename: Troy
authors.initials: T
authors.lastname: Gianduzzo
mesh_terms: D002983:Clinical Competence; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000193:education / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics / Q000193:education* / Q000379:methods; D016896:Treatment Outcome