Initial study of learning curves in robot-assistedradical prostatectomy

Abstract

The application of robot-assisted laparoscopic techniques is new and generates numerous benefits for patients. Here, we summarise the experience of our first series through 52 cases of prostate cancer treated by robot-assisted radical prostatectomy (RARP) in the Department of Urology of Binh Dan Hospital, from December 2016 to September 2017, to study the learning curves of this procedure. In this clinical comparative study, 52 patients diagnosed with prostate cancer (clinical stage T1 to T3) received RARP with and without nerve sparing as well as standard pelvic lymphadenectomy. Patients were divided into 4 groups according to their surgeon (surgeons A, B, C, and D, with 22, 12, 10, and 8 patients, respectively) for comparison. Research variables were cancer stage, pre- and postoperative prostate-specific antigen (PSA) serum levels, Gleason scores, lymph node metastasis, estimated blood loss, surgery time, urinary incontinence, hospital stay, and complications. Mean age, PSA, and stage of cancer were statistically similar (p>0.3). Operative times were 194.55, 269.17, 236.00, and 306.88 min, respectively (p<0.01). Mean estimated blood losses were 363.64, 404.17, 322.22, and 253.75 ml, and were significantly different (p<0.01). Nine patients required blood transfusion. The lengths of hospital stay were 5.73, 12.92, 5.10, and 6.13 days, and were not similar among groups (p<0.05); however, drainage times and complication rates between groups (p<0.01) were statistically significant. The optimal learning curve for operative times was achieved after 20 cases. Our initial RARP results were relatively strong, suggesting that surgery could be safely performed with acceptable complications.