title: A Critical Analysis of the Learning Curve and Postlearning Curve Outcomes of Two Experience- and Volume-Matched Surgeons for Laparoscopic and Robot-Assisted Radical Prostatectomy.
abstract: OBJECTIVE
  There remains equipoise with regard to whether laparoscopic radical prostatectomy (LRP) or robot-assisted radical prostatectomy (RARP) has any benefit over the other. Despite this, there is a trend for the increasing adoption of RARP at great cost to health services across the world. The aim was to critically analyze the learning curve and outcomes for LRP and RARP for two experience- and volume-matched surgeons who have completed the learning curve for LRP and RARP.
  
  
  METHODS
  Two experience- and volume-matched LRP and RARP surgeons who have completed the learning curve were compared with respect to their learning curve and outcomes for RARP and LRP. There were 531 RARP and 550 LRPs analyzed from April 2003 until January 2012 at two relatively high-volume United Kingdom centers. Outcome measures included operative time, blood loss, complication rate (Clavien-Dindo grade III), positive surgical margin (PSM) rate, and early continence rate.
  
  
  RESULTS
  Learning curves for blood loss, operative times, and complication rate were similar between groups. The overall PSM rate and pT2 PSM rate learning curves were longer for RARP compared with LRP but shorter for early continence. Apical PSM showed no learning curve for RARP; however, a long learning curve for LRP and the rate was lower for RARP than for LRP (P=<0.001).
  
  
  CONCLUSIONS
  This study of RARP and LRP identified that both modalities had long learning curves. Despite the long learning curve for RARP, significant benefits in lower PSM rates and better early continence in comparison with LRP exist. There are benefits to patients with RARP over LRP, especially those linked to better apical dissection (apical PSM and early continence).
authors: 1 Department of Urology, Western General Hospital , NHS Lothian, Edinburgh, United Kingdom .|2 Edinburgh Urological Cancer Group, University of Edinburgh , Edinburgh, United Kingdom .
authors: Daniel W
authors: DW
authors: Good
authors: 1 Department of Urology, Western General Hospital , NHS Lothian, Edinburgh, United Kingdom .|2 Edinburgh Urological Cancer Group, University of Edinburgh , Edinburgh, United Kingdom .
authors: Grant D
authors: GD
authors: Stewart
authors: 1 Department of Urology, Western General Hospital , NHS Lothian, Edinburgh, United Kingdom .|2 Edinburgh Urological Cancer Group, University of Edinburgh , Edinburgh, United Kingdom .
authors: Alexander
authors: A
authors: Laird
authors: 3 Department of Urology, University of Leipzig , Leipzig, Germany .
authors: Jens-Uwe
authors: JU
authors: Stolzenburg
authors: 4 Department of Urology, Guy's and St. Thomas' NHS Trust , London, United Kingdom .
authors: Declan
authors: D
authors: Cahill
authors: 1 Department of Urology, Western General Hospital , NHS Lothian, Edinburgh, United Kingdom .|2 Edinburgh Urological Cancer Group, University of Edinburgh , Edinburgh, United Kingdom .
authors: S Alan
authors: SA
authors: McNeill
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods* / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D057212:Therapeutic Equipoise; D016896:Treatment Outcome; D006113:United Kingdom