A multi-institutional study of 3,794 patients undergoing robotic-assisted laparoscopic radical prostatectomy to determine the surgical learning curve for positive margins and operating time.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 102-102 ◽  
Author(s):  
P. Sooriakumaran ◽  
M. John ◽  
R. Leung ◽  
D. Peters ◽  
D. Lee ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Learning Curve ◽  
Operating Time ◽  
Surgical Margin ◽  
Learning Curves ◽  
Laparoscopic Radical Prostatectomy ◽  
Positive Surgical Margin ◽  
Robotic Assisted ◽  
Surgeon Experience ◽  
Surgical Learning

102 Background: The surgical learning curve for robotic assisted laparoscopic radical prostatectomy (RALP) is often cited as being shorter than for other surgical modalities. However, while this appears true with regards to surgical safety, the learning curve for more refined variables like positive surgical margin (PSM) rate and operative time (OT) is not well established. Our objective was to assess the surgical learning curve for RALP in terms of these parameters. Methods: We performed a retrospective cohort study of 3,794 patients who underwent RALP between Jan 2003 and Sep 2009 by three surgeons (DL, PW, AKT) from three centers (UPenn, Karolinska, Cornell). Mean overall PSM rates and mean overall OT were calculated for all three surgeons at intervals of 50 RALPs per surgeon, and learning curves for these means were fit using a loess method. R version 2.71 was used for all statistical analysis. Results: The learning curve for PSM rates for all patients demonstrated improvements that continued with greater surgeon experience, with over 1,600 cases required to get a PSM rate <10%. When only pT3 patients were evaluated, the learning curve started to plateau after 1,000-1,500 cases. Mean OT plateaued after 750 cases although with further surgical experience the OTs started to climb again. Conclusions: The learning curve for RALP is not as short as previously thought, and a large number of cases are needed to get PSM rates and OTs to a minimum. This suggests that RALP should be performed by high volume surgeons in order to optimize patient outcomes. [Table: see text]

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: a single surgeon’s experience in 80 cases after 2 years of formal training

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Sinan Çelen ◽  
Yusuf Özlülerden ◽  
Aslı Mete ◽  
Aykut Başer ◽  
Ömer Levent Tuncay ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Learning Curve ◽  
Complication Rate ◽  
Functional Outcomes ◽  
Surgical Margin ◽  
High Volume ◽  
Laparoscopic Radical Prostatectomy ◽  
Positive Surgical Margin ◽  
Visceral Injury

Abstract Background To assess the learning curve in laparoscopic radical prostatectomy (LRP) performed by a single surgeon who had a healthcare career as a surgical first assistant for 2 years in high-volume centers treating > 150 cases per year. Methods The records of 80 LRP cases performed between October 2017 and August 2018 by a single surgeon were consecutively divided into four groups (groups A = first 20 cases, B = second 20 cases, C = third 20 cases, and D = last 20 cases). The groups were compared in terms of surgical and functional outcomes with a minimum follow-up of 6 months. Results Clinical and surgical stages of the four groups were similar between groups. The operative time (126.8 ± 5.48 min; P = 0.001) and time of removal of the drain (1.65 ± 0.93 days; P = 0.029) were significantly lower in group D; however, hospitalization, catheterization time, and blood loss were similar between groups. The complication rate was low. No patient had a visceral injury, and there were no procedures needed to open conversion. The positive surgical margin (PSM) rates were similar between groups. In terms of continence and potency, all groups were similar at the 6th-month follow-up after surgery. Conclusions Our results showed that prior experience in laparoscopic surgery as a surgical first assistant in a high-volume center improves the learning curve and oncological and functional outcomes, and helps to minimize the complication rate

PATIENTS WITH PRIOR TURP UNDERGOING ROBOTIC ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY HAVE HIGHER POSITIVE SURGICAL MARGIN RATES

2008 ◽  
Vol 179 (4S) ◽  
pp. 606-606 ◽  
Author(s):  
Lance J Hampton ◽  
Ken Jacobsohn ◽  
Rebecca A Nelson ◽  
Laura E Crocitto ◽  
Roger W Satterthwaite ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Laparoscopic Radical Prostatectomy ◽  
Positive Surgical Margin ◽  
Robotic Assisted

scholarly journals Complications, Urinary Continence, and Oncologic Outcomes of Laparoscopic Radical Prostatectomy: Single-Surgeon Experience for the First 100 Cases

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Takashi Imamoto ◽  
Yusuke Goto ◽  
Takanobu Utsumi ◽  
Miki Fuse ◽  
Koji Kawamura ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Intraoperative Complications ◽  
Operating Time ◽  
Positive Margin ◽  
Learning Curves ◽  
Laparoscopic Radical Prostatectomy ◽  
Urinary Continence ◽  
Transfusion Rate ◽  
Estimated Blood Loss ◽  
Surgeon Experience

Objective. The aim of the present study was to evaluate initial learning curves of laparoscopic radical prostatectomy (LRP) with regard to complications, urinary continence, and oncologic outcome.Materials and Methods. We retrospectively reviewed 100 consecutive patients with clinically localized prostate cancer. All 100 patients underwent LRP performed by the same urologist at one institution.Results: Mean operating time (208.4±48.6 min), estimated blood loss (495.8±436.5 mL), allogeneic blood transfusion rate (0%), and intraoperative complications diminished with surgical experience. Positive margin rate varied greatly among pathological stage (positive margin rates: pT2 = 20.5%; pT3 = 63.0%). A trend towards reduction of positive surgical margins in pT2 cases was apparent with increasing experience. Intraoperative and early complications occurred in 2.0% of patients. In all patients, 85.9% used none or no more than one pad per 24 h at 6 months postoperatively. Prostate-specific antigen recurrence was seen in only 2 patients.Conclusions. In the present series of 100 patients, our retrospective evaluation confirms that LRP provides satisfactory results.

scholarly journals The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy: experience of a single surgeon with 500 cases in Taiwan, China

2014 ◽  
Vol 16 (5) ◽  
pp. 728 ◽  
Author(s):  
Yen-Chuan Ou ◽  
VipulR Patel ◽  
Chun-Kuang Yang ◽  
John Wang ◽  
Min-Che Tung ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Learning Curve ◽  
Laparoscopic Radical Prostatectomy ◽  
Robotic Assisted ◽  
Surgical Learning

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.

QUALITY IMPROVEMENT IN LAPAROSCOPIC RADICAL PROSTATECTOMY FOR pT2 PROSTATE CANCER: IMPACT OF VIDEO DOCUMENTATION REVIEW ON POSITIVE SURGICAL MARGIN

2005 ◽  
Vol 173 (3) ◽  
pp. 765-768 ◽  
Author(s):  
KARIM TOUIJER ◽  
KENTARO KUROIWA ◽  
JEFFERY W. SARANCHUK ◽  
WALEED A. HASSEN ◽  
EDOUARD J. TRABULSI ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Quality Improvement ◽  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Laparoscopic Radical Prostatectomy ◽  
Positive Surgical Margin ◽  
Video Documentation
Sign in / Sign up

Export Citation Format

Share Document