Robot-Assisted Laparoscopic Prostatectomy: A Single-Institutions Learning Curve

OBJECTIVES To evaluate the results of robot-assisted laparoscopic prostatectomy (RALP) at a high-volume conventional laparoscopic radical prostatectomy (LRP) center, to determine whether a learning Curve still exists. MATERIAL AND METHODS A total of 293 consecutive men underwent RALP between May 2000 and November 2006. We prospectively collected and reviewed patient data including the preoperative prostate-specific antigen (PSA) and Gleason score, operative duration, and blood loss, duration of hospitalization, and pathologic Gleason score and margin status. RESULTS Mean operative duration for the entire group was 158 +/- 50 minutes, blood loss was 533 +/- 416 mL, hospital duration was 5 days, and mean age was 61 years. Operative time showed a statistically significant decline at 2 different breakpoints: after the first 12 cases, and after 189 cases, dividing the patients into 3 groups. Operative times were 242 +/- 64, 165 +/- 43, and 134 +/- 45 minutes, respectively, for each group. We also evaluated margin Status in the 3 groups. The positive margin rate in each group was 7/12 (58%), 41/180 (23%), and 10/89 (9%), which was statistically significant. Foley catheter duration was also statistically significant among groups. Age, preoperative Gleason score, and PSA were statistically significant between the second and third groups. There was no statistical significance demonstrated in blood loss, postoperative Gleason score, and length of hospital stay. CONCLUSIONS Urologists who are proficient in laparoscopic radical prostatectomy will still have a learning Curve when first performing an RALP. Experienced laparoscopic surgeons demonstrated continued improvement in operative and pathologic parameters with regard to operative duration and positive margin rate as their experience grew. UROLOGY 73: 127-133, 2009. (C) 2009 Published by Elsevier Inc.