First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons.
OBJECTIVE: • To study the outcomes and learning curve of robotic-assisted laparoscopic radical prostatectomy (RALP) in a single centre by two surgeons. PATIENTS AND METHODS: • In total, 500 consecutive patients underwent RALP between 2005 and 2009 carried out by two surgeons. Using an ethically-appr...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
2011
|
| _version_ | 1797099268223270912 |
|---|---|
| author | Sharma, N Papadopoulos, A Lee, D McLoughlin, J Vowler, S Baumert, H Warren, A Patil, V Shah, N Neal, D |
| author_facet | Sharma, N Papadopoulos, A Lee, D McLoughlin, J Vowler, S Baumert, H Warren, A Patil, V Shah, N Neal, D |
| author_sort | Sharma, N |
| collection | OXFORD |
| description | OBJECTIVE: • To study the outcomes and learning curve of robotic-assisted laparoscopic radical prostatectomy (RALP) in a single centre by two surgeons. PATIENTS AND METHODS: • In total, 500 consecutive patients underwent RALP between 2005 and 2009 carried out by two surgeons. Using an ethically-approved database, prospective data collection of demographic, surgical, oncological and functional outcomes (patient reported) was performed, with up to 4 years of follow-up. • The learning curves of both surgeons were analyzed and, in addition, the first 100 and last 100 patients were compared to determine the effect of surgeon experience. RESULTS: • The mean age of the patients was 61.5 years and mean preoperative prostate-specific antigen was 7.0 µg/L. Clinical stages were T1 in 63.2%, T2 in 33.8% and T3 in 3.0% of patients. Median (range) operating time was 170 (63-420) min and median (range) blood loss was 200 (20-3000) mL, with significant improvements for both surgeons with increasing experience (P < 0.001 and P= 0.029, respectively). • Pathological stages were pT2 in 53.4%, pT3a in 41.6%, pT3b in 4.0% and pT4 in 0.6% of patients. Overall, the positive margin rate (PMR) was 24.0% and stage-specific rates were 16.1%, 30.4%, 55.0% and 100.0% for pT2, pT3a, pT3b and pT4 disease, respectively. In the last 50 cases performed by each surgeon, the PMRs for pT2 and pT3a disease were 8.0% and 19.1% (surgeon 1) and 12.9% and 23.5% (surgeon 2). • At 12 months of follow-up, 91.3% of patients were continent and, by 48 months of follow-up, 75% of men with preoperative potency who underwent bilateral nerve-sparing RALP were potent. CONCLUSION: • This is the first report of two surgeons' learning curves in a single centre and shows that key learning curve outcomes continued to improve during the series, suggesting that the learning curve for RALP may be longer than has been previously suggested. |
| first_indexed | 2024-03-07T05:21:21Z |
| format | Journal article |
| id | oxford-uuid:df07527a-876f-41eb-9137-e21fb7cbbc12 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:21:21Z |
| publishDate | 2011 |
| record_format | dspace |
| spelling | oxford-uuid:df07527a-876f-41eb-9137-e21fb7cbbc122022-03-27T09:36:25ZFirst 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:df07527a-876f-41eb-9137-e21fb7cbbc12EnglishSymplectic Elements at Oxford2011Sharma, NPapadopoulos, ALee, DMcLoughlin, JVowler, SBaumert, HWarren, APatil, VShah, NNeal, DOBJECTIVE: • To study the outcomes and learning curve of robotic-assisted laparoscopic radical prostatectomy (RALP) in a single centre by two surgeons. PATIENTS AND METHODS: • In total, 500 consecutive patients underwent RALP between 2005 and 2009 carried out by two surgeons. Using an ethically-approved database, prospective data collection of demographic, surgical, oncological and functional outcomes (patient reported) was performed, with up to 4 years of follow-up. • The learning curves of both surgeons were analyzed and, in addition, the first 100 and last 100 patients were compared to determine the effect of surgeon experience. RESULTS: • The mean age of the patients was 61.5 years and mean preoperative prostate-specific antigen was 7.0 µg/L. Clinical stages were T1 in 63.2%, T2 in 33.8% and T3 in 3.0% of patients. Median (range) operating time was 170 (63-420) min and median (range) blood loss was 200 (20-3000) mL, with significant improvements for both surgeons with increasing experience (P < 0.001 and P= 0.029, respectively). • Pathological stages were pT2 in 53.4%, pT3a in 41.6%, pT3b in 4.0% and pT4 in 0.6% of patients. Overall, the positive margin rate (PMR) was 24.0% and stage-specific rates were 16.1%, 30.4%, 55.0% and 100.0% for pT2, pT3a, pT3b and pT4 disease, respectively. In the last 50 cases performed by each surgeon, the PMRs for pT2 and pT3a disease were 8.0% and 19.1% (surgeon 1) and 12.9% and 23.5% (surgeon 2). • At 12 months of follow-up, 91.3% of patients were continent and, by 48 months of follow-up, 75% of men with preoperative potency who underwent bilateral nerve-sparing RALP were potent. CONCLUSION: • This is the first report of two surgeons' learning curves in a single centre and shows that key learning curve outcomes continued to improve during the series, suggesting that the learning curve for RALP may be longer than has been previously suggested. |
| spellingShingle | Sharma, N Papadopoulos, A Lee, D McLoughlin, J Vowler, S Baumert, H Warren, A Patil, V Shah, N Neal, D First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons. |
| title | First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons. |
| title_full | First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons. |
| title_fullStr | First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons. |
| title_full_unstemmed | First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons. |
| title_short | First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons. |
| title_sort | first 500 cases of robotic assisted laparoscopic radical prostatectomy from a single uk centre learning curves of two surgeons |
| work_keys_str_mv | AT sharman first500casesofroboticassistedlaparoscopicradicalprostatectomyfromasingleukcentrelearningcurvesoftwosurgeons AT papadopoulosa first500casesofroboticassistedlaparoscopicradicalprostatectomyfromasingleukcentrelearningcurvesoftwosurgeons AT leed first500casesofroboticassistedlaparoscopicradicalprostatectomyfromasingleukcentrelearningcurvesoftwosurgeons AT mcloughlinj first500casesofroboticassistedlaparoscopicradicalprostatectomyfromasingleukcentrelearningcurvesoftwosurgeons AT vowlers first500casesofroboticassistedlaparoscopicradicalprostatectomyfromasingleukcentrelearningcurvesoftwosurgeons AT baumerth first500casesofroboticassistedlaparoscopicradicalprostatectomyfromasingleukcentrelearningcurvesoftwosurgeons AT warrena first500casesofroboticassistedlaparoscopicradicalprostatectomyfromasingleukcentrelearningcurvesoftwosurgeons AT patilv first500casesofroboticassistedlaparoscopicradicalprostatectomyfromasingleukcentrelearningcurvesoftwosurgeons AT shahn first500casesofroboticassistedlaparoscopicradicalprostatectomyfromasingleukcentrelearningcurvesoftwosurgeons AT neald first500casesofroboticassistedlaparoscopicradicalprostatectomyfromasingleukcentrelearningcurvesoftwosurgeons |