Positive Surgical Margin Rates During the Robot-assisted Laparoscopic Radical Prostatectomy Learning Curve of an Experienced Laparoscopic Surgeon

Overview

Journal Can Urol Assoc J

Specialty Urology

Date 2017 Oct 27

PMID 29072565

Citations 5

Authors

Anthony F Adili

Julia Di Giovanni

Emma Kolesar

Nathan C Wong

Jen Hoogenes

Shawn Dason

Bobby Shayegan

Affiliations

Soon will be listed here.

Abstract

Introduction: Since its introduction, robot-assisted laparoscopic radical prostatectomy (RARP) has gained widespread popularity, but is associated with a variable learning curve. Herein, we report the positive surgical margin (PSM) rates during the RARP learning curve of a single surgeon with significant previous laparoscopic radical prostatectomy (LRP) experience.

Methods: We performed a prospective cohort study of the first 400 men with prostate cancer treated with RARP by a single surgeon (BS) with significant LRP experience. Our primary outcome was the impact of case timing in the learning curve on margin status. Our analysis was conducted by dividing the case numbers into quartiles (Q1-Q4) and determining if a case falling into an earlier quartile had an impact on margin status relative to the most recent quartile (Q4).

Results: The Q1 cases had an odds ratio for margin positivity of 1.74 compared to Q4 (p=0.1). Multivariate logistic regression did not demonstrate case number to be a significant predictor of PSM. The mean Q1 operative time was 207.4 minutes, decreasing to 179.2 by Q4 (p<0.0001). The mean Q1 estimated blood loss was 255.1 ml, decreasing to 213.6 by Q4 (p=0.0064). There was no change in length of hospitalization within the study period.

Conclusions: Even when controlling for copredictors, a statistically significant learning curve for PSM rate of a surgeon with significant previous LRP experience was not detected during the first 400 RARP cases. We hypothesize that previous LRP experience may reduce the RARP PSM learning curve.

Citing Articles

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Are urologic surgeons performing robot-assisted radical prostatectomy at the University of Alberta meeting surgical quality performance benchmarks? The PROCURE-02 quality assurance study.

Beech B, Follett G, Ghosh S, Rudzinski J, McLarty R, Haines T Can Urol Assoc J. 2020; 14(8):E369-E372.

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Analysis of the Learning Curve of Surgeons without Previous Experience in Laparoscopy to Perform Robot-Assisted Radical Prostatectomy.

Monnerat Lott F, Siqueira D, Argolo H, Lindberg Nobrega B, Campos F, Favorito L Adv Urol. 2018; 2018:9073807.

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