The role of bedside assistant during robot assisted radical prostatectomy: Is more experience better? Analysis on perioperative and clinical outcomes

2020 ◽  
pp. 039156032095108
Author(s):  
Mario Salvatore Mangano ◽  
Claudio Lamon ◽  
Francesco Beniamin ◽  
Alberto De Gobbi ◽  
Matteo Ciaccia ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Operative Time ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
Bedside Assistant ◽  
The Impact

Objectives: To analyze the impact of the bedside assistant’s experience during RARP. It is believed that the outcome of robotic surgery during Robot Assisted Radical Prostatectomy (RARP) for prostate cancer depends not only on the console surgeon’s experience. Materials and Methods: All consecutive RARPs from January 2017 to March 2018 were sourced from a prospectively maintained database. All cases were performed by the same surgeon. He was supported by three bedside assistants: one with bedside and console experience, one only with relevant bedside experience, one basically inexperienced. The patient’s parameters analyzed: age, Body Mass Index (BMI), previous abdominal surgery, prostate volume (by TRUS), pre-operative PSA, bioptic grading. Surgical outcomes analyzed included skin-to-skin operative time and estimated blood loss; clinical outcomes included length of hospital stay and time to catheter removal; the oncological outcome was represented by positive surgical margin rate. Results: A total of 116 RARPs were identified: 38 RARPs were performed with the console experienced bedside assistant, 38 with the experienced one, 40 with the novice one. The variables were similar between the three groups. As far as outcomes are concerned, there were no statistically significant differences between the three bedside assistants in terms of operative time, estimated blood loss, length of stay, days of catheterization, positive surgical margin rate.

scholarly journals Positive surgical margin rates during the robot-assisted laparoscopic radical prostatectomy learning curve of an experienced laparoscopic surgeon

2017 ◽  
Vol 11 (11) ◽  
pp. E409-13 ◽  
Author(s):  
Anthony F. Adili ◽  
Julia Di Giovanni ◽  
Emma Kolesar ◽  
Nathan C. Wong ◽  
Jen Hoogenes ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Learning Curve ◽  
Surgical Margin ◽  
Margin Status ◽  
Laparoscopic Radical Prostatectomy ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
The Mean ◽  
The Impact

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.

scholarly journals Laparoscopic Radical Prostatectomy: The Learning Curve of a Low Volume Surgeon

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Anuar I. Mitre ◽  
Mario F. Chammas ◽  
José Eugênio A. Rocha ◽  
Ricardo Jordão Duarte ◽  
Gustavo Xavier Ebaid ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Loss ◽  
Learning Curve ◽  
Operative Time ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Estimated Blood Loss ◽  
Group A ◽  
Low Volume ◽  
Group B

Objective. Analyze the learning curve for laparoscopic radical prostatectomy in a low volume program.Materials and Methods. A single surgeon operated on 165 patients. Patients were consecutively divided in 3 groups of 55 patients (groups A, B, and C). An enhancement of estimated blood loss, surgery length, and presence of a positive surgical margin were all considered as a function of surgeon’s experience.Results. Operative time was 267 minutes for group A, 230 minutes for group B, and 159 minutes for group C, and the operative time decreased over time, but a significant difference was present only between groups A and C (). Mean estimated blood loss was 328 mL, 254 mL, and 206 mL (). A conversion to open surgery was necessary in 4 patients in group A. Positive surgical margin rates were 29.1%, 21.8%, and 5.5% (). Eight patients in group A, 4 patients in group B, and one in group C had biochemical recurrence.Conclusion. Significantly less intraoperative complications were evident after the first 51 cases. All other parameters (blood loss, operative time, and positive surgical margins) significantly decreased and stabilized after 110 cases. Those outcomes were somehow similar to previous published series by high-volume centers.

scholarly journals Achieving proficiency with robot-assisted radical prostatectomy: Laparoscopic-trained versus robotics-trained surgeons

2013 ◽  
Vol 7 (11-12) ◽  
pp. 711
Author(s):  
Allen Chang ◽  
Armen Derboghossians ◽  
Jennifer Kaswick ◽  
Brian Kim ◽  
Howard Jung ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Laparoscopic Group ◽  
Positive Surgical Margin ◽  
Single Institution ◽  
Robot Assisted ◽  
Community Based ◽  
Kaiser Permanente ◽  
Surgical Tool ◽  
Estimated Blood Loss

Background: Initiating a robotics program is complex, in regards to achieving favourable outcomes, effectively utilizing an expensive surgical tool, and granting console privileges to surgeons. We report the implementation of a community-based robotics program among minimally-invasive surgery (MIS) urologists with and without formal robotics training.Methods: From August 2008 to December 2010 at Kaiser Permanente Southern California, 2 groups of urologists performing robot-assisted radical prostatectomy (RARP) were followed since the time of robot acquisition at a single institution. The robotics group included 4 surgeons with formal robotics training and the laparoscopic group with another 4 surgeons who were robot-naïve, but skilled in laparoscopy. The laparoscopic group underwent an initial 7-day mentorship period. Surgical proficiency was measured by various operative and pathological outcome variables. Data were evaluated using comparative statistics and multivariate analysis.Results: A total of 420 and 549 RARPs were performed by the robotics and laparoscopic groups, respectively. Operative times were longer in the laparoscopic group (p = 0.002), but estimated blood loss was similar. The robotics group had a significantly better overall positive surgical margin rate of 19.9% compared to the laparoscopic group (27.8%) (p = 0.005). Both groups showed improvements in operative and pathological parameters as they accrued experience, and achieved similar results towards the end of the study.Conclusions: Robot-naïve laparoscopic surgeons may achieve similar outcomes to robotic surgeons relatively early after a graduated mentorship period. This study may apply to a community-based practice in which multiple urologists with varied training backgrounds are granted robot privileges.

scholarly journals Reconstruction of the ligamentous apparatus of the lower pelvis in robot-assisted radical prostatectomy as a stage of the learning curve

2021 ◽  
Vol 22 (1) ◽  
pp. 76-84
Author(s):  
Ya. A. Svetocheva ◽  
R. I. Slusarenko ◽  
D. G. Tsarichenko ◽  
R. B. Suhanov ◽  
E. A. Bezrukov ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Loss ◽  
Learning Curve ◽  
Patient Group ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Early Recovery ◽  
Surgical Time ◽  
Urine Retention

Objective of the study. To evaluate results of robot-assisted laparoscopic radical prostatectomy in the framework of a surgeon’s learning curve; to evaluate the effect of reconstruction of the ligamentous apparatus of the lower pelvis on early recovery of urine retention.Materials and methods. 246 patients were divided into 3 groups depending on the surgery date. The analyzed data was accumulated prospectively and retrospectively. Preoperative characteristics (TNM stage, PSA, ISUP), intraoperative characteristics (surgical time, blood loss volume, surgery type and character, type of reconstruction  of the ligamentous apparatus of the lower pelvis) and postoperative characteristics (duration of bladder drainage with a urethral catheter, level and time of recovery for urine retention and erectile function) were evaluated. Reconstruction of the ligamentous apparatus of the lower pelvis was performed through reconstruction of the Denonvillier fascia (Rocco stitch), as well as through suturing fibers of the bladder neck with periurethral tissues and residual puboprostatic ligaments for stabilization of the urethrovesical complex.Results. All operations were successfully completed without conversions or transfusions. Median surgical time was 160 minutes (p = 0.0001). Median blood loss was 173.3 cm3 (p = 0.0002). Mean prostatic volume was 36 cm3  (29–47.5 cm3), and overall frequency of positive surgical margin was 12.82 %. Overall frequency of urine retention recovery was 51.6 % after 3 months, 63.7 % after 6 months (p >0.05). In the patient group with reconstruction of the ligamentous apparatus of the lower pelvis, frequency of urine retention recovery was higher than in the group without reconstruction: 64.1 % vs 45.3 % (after 3 months, р = 0.041) and 74.7 % vs 62.3 % (after 6 months, р = 0.034). Conclusion. Surgical time, blood loss were significantly decreased with the number of performed operative interventions. Significant improvement of early urine retention recovery was observed in the patient group with reconstruction of the ligamentous apparatus of the lower pelvis. 

scholarly journals Prediction of a positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ching-Wei Yang ◽  
Hsiao-Hsien Wang ◽  
Mohamed Fayez Hassouna ◽  
Manish Chand ◽  
William J. S. Huang ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Biochemical Recurrence ◽  
Multivariable Analysis ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Asian Population ◽  
Nerve Sparing ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Surgeon Experience

AbstractThe positive surgical margin (PSM) and biochemical recurrence (BCR) are two main factors associated with poor oncotherapeutic outcomes after prostatectomy. This is an Asian population study based on a single-surgeon experience to deeply investigate the predictors for PSM and BCR. We retrospectively included 419 robot-assisted radical prostatectomy cases. The number of PSM cases was 126 (30.1%), stratified as 22 (12.2%) in stage T2 and 103 (43.6%) in stage T3. Preoperative prostate-specific antigen (PSA) > 10 ng/mL (p = 0.047; odds ratio [OR] 1.712), intraoperative blood loss > 200 mL (p = 0.006; OR 4.01), and postoperative pT3 stage (p < 0.001; OR 6.901) were three independent predictors for PSM while PSA > 10 ng/mL (p < 0.015; hazard ratio [HR] 1.8), pT3 stage (p = 0.012; HR 2.264), International Society of Urological Pathology (ISUP) grade > 3 (p = 0.02; HR 1.964), and PSM (p = 0.027; HR 1.725) were four significant predictors for BCR in multivariable analysis. PSMs occurred mostly in the posterolateral regions (73.8%) which were associated with nerve-sparing procedures (p = 0.012) while apical PSMs were correlated intraoperative bleeding (p < 0.001). A high ratio of pT3 stage after RARP in our Asian population-based might surpass the influence of PSM on BCR. PSM was less significant than PSA and ISUP grade for predicting PSA recurrence in pT3 disease. Among PSM cases, unifocal and multifocal positive margins had a similar ratio of the BCR rate (p = 0.172) but ISUP grade > 3 (p = 0.002; HR 2.689) was a significant BCR predictor. These results indicate that PSA and pathological status are key factors influencing PSM and BCR.

Positive Surgical Margin Trends In Patients With Pathologic T3 Prostate Cancer Treated With Robot Assisted Radical Prostatectomy

2014 ◽  
pp. 150127063130004 ◽  
Author(s):  
Andrew J. Lightfoot ◽  
Yu-Kai Su ◽  
Shailen Shivam Sehgal ◽  
Ziho Lee ◽  
Giovanni H. Greaves ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Robot Assisted

Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 489-497 ◽  
Author(s):  
Juan S. Uribe ◽  
Joshua Beckman ◽  
Praveen V. Mummaneni ◽  
David Okonkwo ◽  
Pierce Nunley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Radiographic Parameters ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND: The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. OBJECTIVE: To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. METHODS: Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t-test and chi-square test were used to evaluate and compare outcomes. RESULTS: A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. CONCLUSION: MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

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