title: Robotic-assisted Laparoscopic Radical Prostatectomy From a Single Chinese Center: A Learning Curve Analysis.
abstract: OBJECTIVE
  To investigate the learning curve of robotic-assisted laparoscopic radical prostatectomy (RALP) and analyze whether a surgeon's prior surgical experience has effects on the surgery.
  
  
  METHODS
  From April 2012 to August 2015, 3 surgeons performed RALP on 355 consecutive patients with prostate cancer. Among these cases, 184 were by surgeon A with prior open experiences, 92 by surgeon B with both open and laparoscopic experiences, and 79 by surgeon C with laparoscopic experiences only. Perioperative, oncological, and functional outcomes were evaluated and compared between surgeons. Learning curve patterns were evaluated to determine the number of cases to reach plateau.
  
  
  RESULTS
  Marked difference was observed in operative time among the 3 groups (all P <.05). Length of hospital stay was also statistically significant (all P <.001), except for that between Group B and Group C (P = .739). Continence at 1-year and 6-month postoperatively was better in Groups B and C compared with Group A (P <.001). Intraoperative blood loss, pathologic stage, positive surgical margin, biochemical recurrence-free rate, and other pathological findings showed no statistical significance between the groups. The number of cases required to reach plateau may vary for surgeons with different surgical experiences.
  
  
  CONCLUSIONS
  Different early surgical background may affect the perioperative parameters of novice RALP surgeons. Previous laparoscopic experiences may provide additional advantage in learning curve parameters compared with surgeons with open experiences only. A better overall continence for laparoscopic surgeons requires further validation.
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Yifan
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Min
authors.initials: M
authors.lastname: Qu
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Linhui
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Yang
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Chen
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Zhu
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Haifeng
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Lu
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Chunfei
authors.initials: C
authors.lastname: Ma
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Zhenkai
authors.initials: Z
authors.lastname: Shi
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Zhenyang
authors.initials: Z
authors.lastname: Dong
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Chuanliang
authors.initials: C
authors.lastname: Xu
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: sunyhsmmu@126.com.
authors.forename: Yinghao
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: gaoxu.changhai@foxmail.com.
authors.forename: Xu
authors.initials: X
authors.lastname: Gao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China; D002983:Clinical Competence; D006801:Humans; D010535:Laparoscopy; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000193:education; D012669:Seminal Vesicles