title: Is the transition from open to robotic prostatectomy fair to your patients? A single-surgeon comparison with 2-year follow-up.
abstract: Robot-assisted radical prostatectomy (RARP) is a procedure thought to require experience with a significant number of cases before mastering. Most RARP series examine outcomes after the learning curve or by combining results from multiple surgeons. We review a single surgeon's experience during the transition from open radical retropubic prostatectomy (RRP) to RARP using a matched case-control model. We prospectively analyzed 50 RARP cases and made comparison with the last 50 consecutive RRP cases. Operative time was longer for RARP than RRP (341 versus 235 min, p < 0.01), and mean estimated blood loss was less for RARP than RRP (533 versus 1,540 ml, p < 0.01). There was a trend towards fewer positive surgical margins (PSM) for RARP (10%) than RRP (24%; p = 0.06). High-risk patients were found to have a greater percentage of PSM following RRP (70%) in comparison with RARP (17%; p = 0.04). The number of patients who experienced complications was no different between groups (16 versus 12, p = 0.37). Erectile function at 12, 18, and 24 months showed no difference between groups (p = 0.15, 0.92, and 0.23, respectively). There was no difference in continence at 1 year (88.6% versus 89.1%; p = 0.94). During 27.1 months of follow-up for the RARP group and 30.4 months for the RRP group, 92% and 94% of patients had an undetectable prostate-specific antigen (PSA) (defined as ≤0.1), respectively (p = 0.38). We report similar outcomes in patients undergoing RARP by a surgeon transitioning from RRP to RARP, confirming that the learning curve does not affect patient outcomes over a 2-year follow-up.
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Avenue, Tarry 16-703, Chicago, IL, 60611, USA. r-nadler@northwestern.edu.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nadler
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Avenue, Tarry 16-703, Chicago, IL, 60611, USA.
authors.forename: Jessica T
authors.initials: JT
authors.lastname: Casey
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Avenue, Tarry 16-703, Chicago, IL, 60611, USA.
authors.forename: Lee C
authors.initials: LC
authors.lastname: Zhao
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Avenue, Tarry 16-703, Chicago, IL, 60611, USA.
authors.forename: Neema
authors.initials: N
authors.lastname: Navai
authors.affiliation: University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA.
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: Smith
authors.affiliation: Kaiser Permanente Los Angeles, 4733 Sunset Blvd, Los Angeles, CA, 90027, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Zhumkhawala
authors.affiliation: NorthShore University HealthSystem, 9711 Skokie Blvd, Skokie, IL, 60077, USA.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Macejko
keywords: Learning curve; Open; Prostate cancer; Prostatectomy; Robotic