The Learning Curve During the Development of a Robotic Prostatectomy Program

Harold A Frazier, Jason D Engel
George Washington University Medical Center, Washington, DC

Introduction:
We performed a detailed evaluation of our learning curve during the earliest phases of a robotic prostatectomy program.
Methods:
100 patients underwent a daVinci robotic assisted laparoscopic radical prostatectomy (dVRP) at our institution from Feb 2004 to March 2005. Demographic and surgical OR data was collected prospectively. Data was collated by groups of 10 patients to monitor and critique progress.
Results:
Mean age was 59.4 years (range: 44 - 72). Typical Body Mass Index was 27.0 (range: 19.9 - 47.0). Average preoperative PSA and Gleason scores were 6.1 (range: 1.4 - 21) and 6.4 (range: 4 - 9) respectively. Placing the ports, docking the robot, dropping the bladder, and endopelvic dissection showed modest improvement over time. Suture ligature of the DVC initially took 25 minutes, but beyond 30 patients averaged 8 minutes. Prostatic dissection initially took two hours, but has dropped to under 60 minutes. Completion of the anastomosis decreased from 60 to 35 minutes. Total robot time for the first 20 cases averaged over 4 hours; we now average 143 minutes. Average total surgical time started at 369 minutes, and now averages 191 minutes. Total OR time decreased from 430 to 240 minutes. Four conversions were required. Five complications included 1 rectal injury, 1 surgical bleed, 2 prolonged urinary leaks, and 1 BNC.
Conclusions:
Successful implementation of a new urologic robotics program requires a team approach. Continuous improvement in efficiency and expertise occurred through the first 40 patients, with the learning curve leveling off thereafter.

Back to Final Program