Factors predicting prolonged operative time for individual surgical steps of robot-assisted radical prostatectomy (RARP): A single surgeon's experience.
BACKGROUND
We evaluated the average time required to complete individual steps of robotic-assisted radical prostatectomy (RARP) by an expert RARP surgeon. The intent is to help establish a time-based benchmark to aim for during apprenticeship. In addition, we aimed to evaluate preoperative patient factors, which could prolong the operative time of these individual steps.


METHODS
We retrospectively identified 247 patients who underwent RARP, performed by an experienced robotic surgeon at our institution. Baseline patient characteristics and the duration of each step were recorded. Multivariate analysis was performed to predict factors of prolonged individual steps.


RESULTS
In multivariable analysis, obesity was a significant predictor of prolonged operative time of: docking (odds ratio [OR] 1.96), urethral division (OR 3.13), and vesico-urethral anastomosis (VUA) (OR 2.63). Prostate volume was also a significant predictor of longer operative time in dorsal vein complex ligation (OR 1.02), bladder neck division (OR 1.03), pedicle control (OR 1.04), urethral division (OR 1.02), and VUA (OR 1.03). A prolonged bladder neck division was predicted by the presence of a median lobe (OR 5.03). Only obesity (OR 2.56) and prostate volume (OR 1.04) were predictors of a longer overall operative time.


CONCLUSIONS
Obesity and prostate volume are powerful predictors of longer overall operative time. Furthermore, both can predict prolonged time of several individual RARP steps. The presence of a median lobe is a strong predictor of a longer bladder neck division. These factors should be taken into consideration during RARP training.
Division of Urology, Centre Hospitalier de l'Université de Montréal, QC; ; Division of Robotic Urology, Hôpital Sacré Cœur de Montréal, QC;
Abdullah M
AM
Alenizi
Division of Urology, Centre Hospitalier de l'Université de Montréal, QC;
Roger
R
Valdivieso
Division of Urology, Centre Hospitalier de l'Université de Montréal, QC; ; Division of Robotic Urology, Hôpital Sacré Cœur de Montréal, QC;
Emad
E
Rajih
Division of Urology, Centre Hospitalier de l'Université de Montréal, QC;
Malek
M
Meskawi
Division of Urology, Centre Hospitalier de l'Université de Montréal, QC;
Cristian
C
Toarta
Division of Urology, Centre Hospitalier de l'Université de Montréal, QC;
Marc
M
Bienz
Division of Urology, Centre Hospitalier de l'Université de Montréal, QC;
Mounsif
M
Azizi
Division of Urology, Centre Hospitalier de l'Université de Montréal, QC;
Pierre Alain
PA
Hueber
Division of Urology, Centre Hospitalier de l'Université de Montréal, QC;
Hugo
H
Lavigueur-Blouin
Division of Urology, Centre Hospitalier de l'Université de Montréal, QC;
Vincent
V
Trudeau
Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Quoc-Dien
QD
Trinh
Division of Robotic Urology, Hôpital Sacré Cœur de Montréal, QC;
Assaad
A
El-Hakim
Division of Urology, Centre Hospitalier de l'Université de Montréal, QC;
Kevin C
KC
Zorn