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Impact Of Prior Laparoscopic Experience On Skill Acquisition For Robotic-Assisted Laparoscopic Prostatectomy
Justin D Harmon, Monique Wilson*, Raul O Parra
Cooper University Hospital, Robert Wood Johnson Medical School, Camden, NJ
Introduction: There is no clear evidence that previous experience with laparoscopic surgery is an advantage in acquiring proficiency in robotic-assisted laparoscopic prostatectomy(RALP). We reviewed the results of two surgeons during their initial cases to determine whether previous LRP experience accelerates the learning curve for RALP.
Methods: During a 20-month period, two surgeons performed 110 consecutive RALP’s. Surgeon 1 has an endourology background, ample experience with LRP and modest experience with open prostatectomy. Surgeon 2 is a trained urologic oncologist with extensive experience in open prostatectomy and limited experience with LRP. Data was analyzed to determine total operative time, blood loss, complications and surgical margins. In addition, the number of cases taken to achieve a steady total operative time of less than 4.5 hours was used to determine proficiency.
Results: Both groups were identical with respect to age and PSA. There was no difference between Surgeon 1 and 2 with regards to blood loss and hospital stay(p>0.05). Surgeon 1 required 30 cases to consistently maintain an operative time of <4.5 hours and Surgeon 2 achieved proficiency after 6 procedures. Surgeon 1 encountered 5 complications in cases 1-30(16%) and 3 in cases 31-62(9.3%) while Surgeon 2 had a total of 3 complications(6.2%). The overall positive surgical margin rate for Surgeons 1 and 2 was 16% and 11% respectively(p<0.05).
Conclusions: Our data indicates that previous experience with LRP is not necessary to achieve proficiency with RALP. However, skill and experience with open radical prostatectomy appears to facilitate competence with RALP.
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