title: Impact of trainee involvement with robotic-assisted radical prostatectomy.
abstract: Robotic-assisted surgery has been rapidly adopted within urology practice. As a result, academic centers are challenged with the burden of how to effectively train residents and fellows to perform robotic-assisted surgery without compromising outcomes. We evaluated the perioperative outcomes of trainee involvement with robotic-assisted radical prostatectomy (RARP) within our healthcare organization. We retrospectively reviewed RARP cases performed at our institution between September 2008 and December 2010 using a single da Vinci robotic platform. Trainees consisted of urology residents and fellows who operated with staff surgeons on select operating days, whereas two staff surgeon teams performed RARP on alternate days. We compared clinicopathologic variables including operating time, estimated blood loss, surgical margin rates, and complication rates between the trainee and staff-only surgeon groups. Overall, 1,019 RARP surgeries were performed within the study period and trainees participated in 162 cases (16 %). Clinical characteristics were similar between men undergoing surgery with a trainee and those without. Positive surgical margin rates were lower for patients with pT2 disease for cases with trainee involvement (11 vs. 19 %, p = 0.02), although overall margin rates and margin rates for patients with pT3 disease were similar between the groups (p = 0.34). Surgical cases involving trainees were longer (241 vs. 200 min, p < 0.001) and resulted in higher estimated blood loss (190 vs. 120 mL, p < 0.001) than the two staff surgeon cases. However, transfusion rates as well as intraoperative and postoperative complication rates did not differ significantly between groups. In conclusion, surgical margin rates were lower in teaching cases for patients with pT2 disease. Importantly, trainee involvement in RARP is safe, with similar perioperative outcomes to staff-only surgical cases. This information may be useful for training and surgical planning.
authors.affiliation: Department of Urology, Kaiser Permanente Los Angeles Medical Center, Kaiser Permanente Southern California, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA. anil.a.thomas@kp.org.
authors.forename: Anil A
authors.initials: AA
authors.lastname: Thomas
authors.affiliation: Department of Urology, Kaiser Permanente Los Angeles Medical Center, Kaiser Permanente Southern California, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA.
authors.forename: Armen
authors.initials: A
authors.lastname: Derboghossians
authors.affiliation: Department of Urology, Kaiser Permanente Los Angeles Medical Center, Kaiser Permanente Southern California, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA.
authors.forename: Allen
authors.initials: A
authors.lastname: Chang
authors.affiliation: Department of Urology, Kaiser Permanente Los Angeles Medical Center, Kaiser Permanente Southern California, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Karia
authors.affiliation: Department of Urology, Kaiser Permanente Los Angeles Medical Center, Kaiser Permanente Southern California, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Finley
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Slezak
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
authors.affiliation: Department of Urology, Kaiser Permanente Los Angeles Medical Center, Kaiser Permanente Southern California, 4900 Sunset Blvd, 2nd Floor, Los Angeles, CA, 90027, USA.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Chien
keywords: Complications; Learning curves; Morbidity; Robotic prostatectomy; Training