title: Comparative investigation on clinical outcomes of robot-assisted radical prostatectomy between experienced open prostatic surgeons and novice open surgeons in a laparoscopically naïve center with a limited caseload.
abstract: OBJECTIVE
  To compare perioperative, oncological and functional outcomes of robot-assisted radical prostatectomy between experienced and novice open radical prostatectomy surgeons in a laparoscopically naïve center with a limited caseload.
  
  
  METHODS
  Six surgeons carried out robot-assisted radical prostatectomy in 154 patients, which were divided into the following three groups: group 1 (n = 90), including patients operated on by a surgeon with experience in both open radical prostatectomy and robot-assisted radical prostatectomy; group 2 (n = 36), including patients operated on by two surgeons with experience in open radical prostatectomy only; and group 3 (n = 28), including patients operated on by three surgeons with limited experience in both open radical prostatectomy or robot-assisted radical prostatectomy.
  
  
  RESULTS
  Groups 2 and 3 did not differ significantly in their median values of external blood loss (P = 0.165) or console time (P = 0.103). Positive surgical margin rates for pT2 patients were also similar in these two groups: 21.2% (7/33) in group 2 and 22.7% (5/22) in group 3 (P = 0.894). Kaplan-Meier analysis showed that 12 months after robot-assisted radical prostatectomy the prostate-specific antigen-free rate for pT2 patients was 96.0% in group 2 and 100% in group 3, but the pad-free continence rate was just 91.0% in group 1, 88.0% in group 2 and 75.5% in group 3 (group 1 vs group 3, P = 0.037; group 2 vs group 3, P = 0.239). The major complication rate after robot-assisted radical prostatectomy was 3.3% (3/90) in group 1, 11.1% (4/36) in group 2 and 17.9% (5/28) in group 3 (group 1 vs group 3, P = 0.008; group 2 vs group 3; P = 0.441).
  
  
  CONCLUSIONS
  Robot-assisted radical prostatectomy offers satisfactory postoperative outcomes even when carried out by surgeons with limited experience in open radical prostatectomy.
authors.affiliation: Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Sumitomo
authors.forename: Kent
authors.initials: K
authors.lastname: Kanao
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Kato
authors.forename: Takahiko
authors.initials: T
authors.lastname: Yoshizawa
authors.forename: Masahito
authors.initials: M
authors.lastname: Watanabe
authors.forename: Kenji
authors.initials: K
authors.lastname: Zennami
authors.forename: Kogenta
authors.initials: K
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011361:Professional Competence; D011467:Prostate / Q000601:surgery*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures; D066231:Surgeons; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen
keywords: clinical outcomes; learning curve; novice open radical prostatectomy surgeon; parallel learning; robot-assisted radical prostatectomy