title: Can robot-assisted radical prostatectomy be taught to chief residents and fellows without affecting operative outcomes?
abstract: OBJECTIVE
  To determine whether robot-assisted radical prostatectomy (RARP) may be taught to chief residents and fellows without influencing operative outcomes.
  
  
  METHODS
  Between August 2011 and June 2012, 388 patients underwent RARP by a single primary surgeon (DIL) at our institution. Our teaching algorithm divides RARP into five stages, and each trainee progresses through the stages in a sequential manner. Statistical analysis was conducted after grouping the cohort according to the surgeons operating the robotic console: attending only (n = 91), attending and fellow (n = 152), and attending and chief resident (n = 145). Approximately normal variables were compared utilizing one-way analysis of variance, and categorical variables were compared utilizing two-tailed χ(2) test; P < 0.05 was considered statistically significant.
  
  
  RESULTS
  There was no difference in mean age (P = 0.590), body mass index (P = 0.339), preoperative SHIM (Sexual Health Inventory for Men) score (P = 0.084), preoperative AUASS (American Urologic Association Symptom Score) (P = 0.086), preoperative prostate-specific antigen (P = 0.258), clinical and pathological stage (P = 0.766 and P = 0.699, respectively), and preoperative and postoperative Gleason score (P = 0.775 and P = 0.870, respectively). Operative outcomes such as mean estimated blood loss (P = 0.807) and length of stay (P = 0.494) were similar. There was a difference in mean operative time (P < 0.001; attending only = 89.3 min, attending and fellow 125.4 min, and attending and chief resident 126.9 min). Functional outcomes at 3 months and 1 year postoperatively such as urinary continence rate (P = 0.977 and P = 0.720, respectively), and SHIM score (P = 0.661 and P = 0.890, respectively) were similar. The rate of positive surgical margins (P = 0.058) was similar.
  
  
  CONCLUSIONS
  Training chief residents and fellows to perform RARP may be associated with increased operative times, but does not compromise short-term functional and oncological outcomes.
authors.affiliation: Department of Urology, Temple University Hospital, Philadelphia, PA, USA.
authors.forename: Ziho
authors.initials: Z
authors.lastname: Lee
authors.affiliation: Division of Urology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lightfoot
authors.affiliation: Division of Urology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Mucksavage
authors.affiliation: Division of Urology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Lee
keywords: Education; Minimally invasive surgery; Prostatectomy