title: Achieving proficiency with robot-assisted radical prostatectomy: Laparoscopic-trained versus robotics-trained surgeons.
abstract: BACKGROUND
  Initiating a robotics program is complex, in regards to achieving favourable outcomes, effectively utilizing an expensive surgical tool, and granting console privileges to surgeons. We report the implementation of a community-based robotics program among minimally-invasive surgery (MIS) urologists with and without formal robotics training.
  
  
  METHODS
  From August 2008 to December 2010 at Kaiser Permanente Southern California, 2 groups of urologists performing robot-assisted radical prostatectomy (RARP) were followed since the time of robot acquisition at a single institution. The robotics group included 4 surgeons with formal robotics training and the laparoscopic group with another 4 surgeons who were robot-naïve, but skilled in laparoscopy. The laparoscopic group underwent an initial 7-day mentorship period. Surgical proficiency was measured by various operative and pathological outcome variables. Data were evaluated using comparative statistics and multivariate analysis.
  
  
  RESULTS
  A total of 420 and 549 RARPs were performed by the robotics and laparoscopic groups, respectively. Operative times were longer in the laparoscopic group (p = 0.002), but estimated blood loss was similar. The robotics group had a significantly better overall positive surgical margin rate of 19.9% compared to the laparoscopic group (27.8%) (p = 0.005). Both groups showed improvements in operative and pathological parameters as they accrued experience, and achieved similar results towards the end of the study.
  
  
  CONCLUSIONS
  Robot-naïve laparoscopic surgeons may achieve similar outcomes to robotic surgeons relatively early after a graduated mentorship period. This study may apply to a community-based practice in which multiple urologists with varied training backgrounds are granted robot privileges.
authors.affiliation: Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA;
authors.forename: Brian
authors.initials: B
authors.lastname: Kim
authors.forename: Allen
authors.initials: A
authors.lastname: Chang
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kaswick
authors.forename: Armen
authors.initials: A
authors.lastname: Derboghossians
authors.forename: Howard
authors.initials: H
authors.lastname: Jung
authors.forename: Jeff
authors.initials: J
authors.lastname: Slezak
authors.forename: Melanie
authors.initials: M
authors.lastname: Wuerstle
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Williams
authors.forename: Gary W
authors.initials: GW
authors.lastname: Chien