Background: Robotic-assisted laparoscopic radical prostatectomy (RALRP) has gained popularity in the United States due to claims of its superior 3-dimensional magnified vision and improved manual dexterity for surgeons that shorten the learningcurve and facilitate the transition from standard open radical prostatectomyto laparoscopic prostatectomy as a minimally invasive procedure. The Canadian health care system, however, faces unique challenges when dealing with theintroduction of new technologies. We report the initial experience with the useof the da Vinci robot for RALRP at the University of Western Ontario.Methods: We retrospectively reviewed the records of the initial 30 cases ofRALRP with a minimum of 6 months follow-up. Data included the surgical times of various operative segments from cases 1–15 and 16–30, perioperative complications,early oncology and early functional results.Results: The lack of dedicated resources initially led to sporadic and infrequentcases. Nevertheless, there was improvement in surgical proficiency with significantdifference in operative times between cases 1–15 and 16–30. Perioperativecomplications, though significant, were commensurate with reported early experiencesfrom other centres worldwide, which reflects the learning curve with RALRP.Conclusion: Initiating a new surgical program that involves significant capital andmaintenance costs, such as an RALRP program, within the Canadian healthcare system poses unique challenges for the surgical team. Nevertheless, ourinitial experience has encouraged us to proceed with the next phase of evaluationfor the urological and oncological application of the technology.
Single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy (spRALP): Initial experience
