title: Impact of Resident Involvement on Robot-Assisted Radical Prostatectomy Outcomes.
abstract: This study examines perioperative outcomes of resident involvement during various steps of robot-assisted radical prostatectomy (RARP).
  
  
  
  The RARP procedure was divided into seven steps: bladder takedown (BTD), endopelvic fascia, bladder neck (BN), seminal vesicle/vas deferens, pedicle/nerve sparing, apex, and anastomosis. Three hundred seventy-two RARPs performed by a single surgeon were analyzed. Resident console time during each of the seven steps was recorded. Perioperative variables were compared to surgeon-only cases.
  
  
  
  Residents performed on the console for 232 of 372 cases (62.4%). Estimated blood loss (p = 0.09), transfusion (p = 0.11), and complications (p = 0.33) were no different between surgeon-only and resident-involved cases. Mean operating room time (ORT) was less for the surgeon-only cases (190.4 vs 206.4 minutes, p = 0.003). There was no difference in positive margins (p = 0.79), length of stay (LOS) (p = 0.30), catheter days (p = 0.17), readmission (p = 0.33), or reoperation (p = 0.73) when comparing surgeon-only to resident-involved cases. Residents performing the BN step had no effect on BN margins (p = 0.73) or prolonged catheterization (p = 0.62). ORT was significantly prolonged if BTD was performed by a resident (233.0 vs 191.7 minutes, p < 0.0001). Residents performing anastomosis had no effect on prolonged catheter time (p = 0.62) or LOS (p = 0.20). Residents were more likely to be involved in at least one portion of RARP following the purchase of a Mimic simulator (Mimic Technologies, Inc., Seattle, WA) in January 2012.
  
  
  
  Supervised resident console involvement in RARP does not affect perioperative outcomes, although, it prolongs ORT, with the BTD step having the most effect on ORT.
authors.affiliation: 1 Department of Urology, Mayo Clinic Florida , Jacksonville, Florida.
authors.forename: Eric
authors.initials: E
authors.lastname: Schommer
authors.affiliation: 1 Department of Urology, Mayo Clinic Florida , Jacksonville, Florida.
authors.forename: Kolbi
authors.initials: K
authors.lastname: Tonkovich
authors.affiliation: 2 Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic , Jacksonville, Florida.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Li
authors.affiliation: 1 Department of Urology, Mayo Clinic Florida , Jacksonville, Florida.
authors.forename: David D
authors.initials: DD
authors.lastname: Thiel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D012669:Seminal Vesicles; D000071077:Surgical Oncology / Q000193:education*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology; D014572:Urology / Q000193:education*
keywords: education; prostate; robotics