INDIVIDUAL LEARNING CURVE FOR RADICAL ROBOT-ASSISTED PROSTATECTOMY BASED ON THE EXAMPLE OF THREE PROFESSIONALS WORKING IN ONE CLINIC


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Abstract

The appearance of new surgical technique always requires evaluation of its effectiveness and ease of acquisition. A comparative study of the results of the first three series of successive robot-assisted radical prostatectomy (RARP) performed on at time by three surgeons, was conducted. The series consisted of 40 procedures, and were divided into 4 groups of 10 operations for the analysis. When comparing data, statistically significant improvement of intra- and postoperative performance in each series was revealed, with increase in the number of operations performed, and in each subsequent series compared with the preceding one. We recommend to perform the planned conversion at the first operation. In our study, previous laparoscopic experience did not provide any significant advantages in the acquisition of robot-assisted technology. To characterize the individual learning curve, we recommend the use of the number of operations that the surgeon looked in the life-surgery regimen and/or in which he participated as an assistant before his own surgical activity, as well as the indicator «technical defect». In addition to the term «individual learning curve», we propose to introduce the terms «surgeon’s individual training phase» and «clinic’s learning curve».

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About the authors

P. I Rasner

MSMSU n.a. A.I. Evdokimov; CCH №50

Email: dr.rasner@gmail.com
PhD in Medical Sciences, Associate Professor at the, Department of Urology; Head of the 4th urological unit

D. Yu Pushkar

MSMSU n.a. A.I. Evdokimov

Department of Urology

K. B Kolontarev

MSMSU n.a. A.I. Evdokimov

Department of Urology

D. V Kotenko

MSMSU n.a. A.I. Evdokimov

Department of Urology

References

  1. Широкорад В.И., Максон А.Н., Ядыков О.А. Состояние онкоурологической помощи в Москве. Онкоурология. 2013;4:10-13.
  2. Ficarra V. et al. Evidence from Robot-Assisted Laparoscopic Radical Prostatectomy: A Systematic Review. Eur. Urol. 2007;51:45-56.
  3. Novara G. et al. Systematic Review and Meta-analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Prostatectomy Eur. Urol. 2012;62:431-452.
  4. Wood D.P., Wolf J.S. Oncology rather than laparoscopy surgical experience is more important in learning to perform a robot-assisted laparoscopic radical prostatectomy. J Urol. 2004; 171(4 Suppl; Abstract 813):215.
  5. Menon M. Robotic radical retropubic prostatectomy. BJU Int. 2003;91:175-176.
  6. Artibani W., Fracalanza S., Cavalleri S. et al. Learning curve and preliminary experience with da Vinci-assisted laparoscopic radical prostatectomy. Urol Int. 2008;80(3):237-244.
  7. Ahlering T.E., Skarecky D., Lee D. et al. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol. 2003;170:1738-1741.
  8. Binder J., Kramer W. Robotically assisted laparoscopic radical prostatectomy. BJU Int. 2001;87(4):408-410.
  9. Menon M., Tewari A., Baize B. et al. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology 2002;60: 864-868.
  10. Menon M., Shrivastava A., Tewari A. et al. Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol. 2002;168:945-949.
  11. Ahlering T.E., Woo D., Eichel L. et al. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes. Urology 2004;63(5):819-822.
  12. Fracalanza S., Ficarra V., Cavalleri S. et al. Is roboticallyassisted laparoscopic radical prostatectomy less invasive than retropubic radical prostatectomy? Results from a prospective, unrandomized, comparative study. BJU Int 2008; 101:1145-1149.
  13. Zorn K.C., Gofrit O.N., Orvieto M.A. et al. Robotic-assisted laparoscopic prostatectomy: functional and pathologic outcomes with interfascial nerve preservation. Eur. Urol. 2007;51:755-763.
  14. Zorn K.C., Wille M.A., Thong A.E. et al. Continued improvement of perioperative, pathological and continence outcomes during 700 robot-assisted radical prostatectomies. Can J Urol. 2009;16:4742-4749.
  15. Cho J.W., Kim T.H., Sung G.T. Laparoscopic radical prostatectomy versus robot-assisted laparoscopic radical prostatectomy: a single surgeon’s experience. Korean J Urol. 2009;50:1198-1202.
  16. Park J.W., Won Lee H., Kim W. et al. Comparative assessment of a single surgeon’s series of laparoscopic radical prostatectomy: conventional versus robot-assisted. J Endourol. 2011;25:597-602.
  17. Patel V.R., Tully A.S., Holmes R. et al. Robotic radicalprostatectomy in the community setting - the learning curve and beyond: initial 200 cases. J Urol. 2005;174:269-272.

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