Experienced bedside-assistants improve operative outcomes for surgeons early in their learning curve for robot assisted laparoscopic radical prostatectomy

Robot-assisted laparoscopic radical prostatectomy (RALP) relies heavily on the bedside assistant (BA). Currently, the relationship between BA experience and surgical outcomes in robotic surgery is not clear. We examined whether bedside assistant experience can significantly affect positive margin rate and peri-operative outcomes for RALP for surgeons within their learning curve. A retrospective cohort study of a single surgeon's peri-operative outcomes during RALP was examined and compared with and without an experienced bedside assistant. Patient demographic data and peri-operative data, margin rate, and length of stay (LOS), were collected and analyzed. Univariate and multivariable analyses were performed to determine if expert BA was a predictor of post-operative outcomes. In total, 170 consecutive cases over three years were analyzed. 111 (65%) were performed without an expert BA. The two groups were not significantly different with regards patient demographics (p > 0.05). On univariate analysis, having an expert BA was associated with a significantly lower LOS (31 h +/- 21 vs. 42 h +/- 26,p = 0.004), EBL (296 ml +/- 180 vs. 441 ml +/- 305,p < 0.0001) and positive margin rate (20% vs. 37%,p = 0.03). Other surgical outcomes were comparable between groups. On multivariable analysis, expert BA remained a predictor of, EBL (B stat = - 146, 95% CI - 240 to - 52,p = 0.003) and positive margin rate (OR 0.4, 95% CI 0.2-0.96,p = 0.04). Our results demonstrate that the use of an expert BA may result in improved patient outcomes early in the learning curve of RALP, most notably, positive margin rate and estimated blood loss.

Automated summary

The study found that in robot-assisted laparoscopic radical prostatectomy, having an experienced bedside assistant can significantly reduce positive margin rates and improve peri-operative outcomes, particularly by decreasing estimated blood loss and length of hospital stay.