Team-based approach reduces learning curve in robot-assisted laparoscopic radical prostatectomy

Aim: We assessed the team approach in reducing the learning curve during our 2-year experience transiting from open to robot-assisted laparoscopic radical prostatectomy (rLRP). Methods: A team of three urologists progressed through assistant phase to console phase to obtain competency in robotic prostatectomy. One hundred patients underwent rLRP by this team using the da Vinci robotic surgical system from I February 2003 to 15 May 2005. Results: The immediate perioperative outcome was divided into three corresponding time frames and the results demonstrated gradual improvement in outcome parameters. The mean set-up time and dissection time were 24 +/- 14 min and 182 +/- 52 min, respectively. The mean perioperative blood loss was 272 +/- 240 mL, and 7% of patients (n = 7) required blood transfusion. The mean duration of bladder catheterization was 8.4 +/- 4.1 days, and mean hospital stay was 2.9 +/- 1.6 days. There was no perioperative mortality or conversion to open radical prostatectomy. Major complications (4%) included urethrovesical leak requiring reoperation, postoperative cerebrovascular accident, and transient ureteric obstruction. Minor complications (7%) included minor urethrovesical leak, bladder neck stenosis, and urinary tract infection. Mean follow up was 6.6 +/- 5.0 months. Pathological assessment showed pT2 disease in 55% and pT3 in 45% of specimens. Conclusions: A team-based approach to robot-assisted LRP helped to reduce the learning curve of the procedure for individual surgeons and continued to show significantly lower perioperative blood loss, transfusion requirements and postoperative pain compared to open radical retropubic prostatectomy.