Laparoscopic and robot assisted radical prostatectomy: Establishment of a structured program and preliminary analysis of outcomes

Purpose: The technique of laparoscopic radical prostatectomy is difficult to master and is associated with a steep learning curve. We hypothesized that a structured approach to establishing a laparoscopic prostatectomy program would diminish complications during the learning process and that robotic technology would be useful in learning the operation. Materials and Methods: A structured laparoscopic radical prostatectomy program was introduced at the Vattikuti Urology Institute on October 23, 2000. One of 2 surgeons with a combined experience of more than 500 laparoscopic radical prostatectomies performed or supervised the first prostatectomies, training a third surgeon with extensive open surgical skills but no laparoscopic experience. The trained surgeon then started performing the operation independently with robotic assistance. The results of this approach were analyzed at the end of 12 months. Results: We performed 48 laparoscopic radical prostatectomies and 50 robot assisted prostatectomies within the 12-month period. The preoperative and intraoperative demographical variables were comparable in both groups as were the operative times, changes in hemoglobin concentrations, durations of hospitalization, positive margin rates and overall complication rates. All measured parameters were comparable to the best-in-class values for laparoscopic radical prostatectomy reported in the literature. Conclusions: A structured approach minimizes complications during the establishment of laparoscopic radical prostatectomy program. Robotic assistance helps skilled open surgeons learn the technique of laparoscopic radical prostatectomy.