Learning curve of robotic-assisted radical prostatectomy with 60 initial cases by a single surgeon

Abstract

Objective: We tracked various proficiency indicators for the learning curve as a single Taiwanese surgeon became familiar with robotic-assisted laparoscopic radical prostatectomy surgeries by performing 60 initial procedures.

Methods: Between December 2005 and December 2007, 60 consecutive patients were classified into Group 1 (Cases 1-30) or Group 2 (Cases 31-60). Pre-operative clinical characteristics, operative parameters, and postoperative parameters were assessed.

Results: Pre-operative biopsy Gleason scores were significantly higher in Group 2 than in Group 1 (7.03 vs. 6.13, P < 0.01). The vesicourethral anastomosis time showed a statistically significant reduction from 46.38 minutes in Group 1 to 31 minutes in Group 2 (p < 0.01). The continence rate at 3 months in Group 2 was higher than that in Group 1 (97.6%vs. 76.7%, p = 0.052); the mean duration to continence was shorter in Group 2 than Group 1 (70.26 ± 67.37 days vs. 39.63 ± 36.48 days, p = 0.056). Group 2 had shorter postoperative stays (3.93 vs. 7.33) and longer durations of Foley catheter removal (9.0 vs. 7.7) than Group 1, representing a statistically significant difference (p < 0.01).

Conclusion: After gaining experience by performing an initial 30 robotic-assisted laparoscopic radical prostatectomies, the subsequent 30 surgeries established proficiency as determined by vesicourethral anastomosis time and early continence rate.