Robotic-assisted Laparoscopic Radical Prostatectomy From a Single Chinese Center: A Learning Curve Analysis

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• 作者：Yifan Chang¹ ; Min Qu¹ ; Linhui Wang ; Bo Yang ; Rui Chen ; Feng Zhu ; Haifeng Wang ; Yan Wang ; Xin Lu ; Chunfei Ma ; Zhenkai Shi ; Zhenyang Dong ; Huan Chen ; Chuanliang Xu ; Yinghao Sun ; ^{sunyhsmmu@126.com" class="auth_mail" title="E-mail the corresponding author} ; Xu Gao ; ^{gaoxu.changhai@foxmail.com" class="auth_mail" title="E-mail the corresponding author}
• 刊名：Urology
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：93
• 期：Complete
• 页码：104-111
• 全文大小：744 K

文摘

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.

Patients and 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.

Conclusion

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.