Impact of a single-surgeon learning curve on complications, positioning injuries, and renal function in patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection - Abstract

OBJECTIVE: To assess the impact of a single-surgeon learning curve on complications, positioning injuries, and renal function in patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection for intermediate- or high-risk clinically localized prostate cancer.

METHODS: From November 2008 to October 2012, a total of 233 consecutive patients were treated by a single surgeon experienced in open and laparoscopic procedures. Four subgroups of patients (1: cases 1-59; 2: 60-117; 3: 118-175; and 4: 176-233) were compared. Complications were classified according to the modified Clavien system. Serum creatine kinase, as an indicator of tissue injury, was measured before, during, and for 5 days after surgery. Renal function monitoring was started preoperatively and ended at discharge. Minimum follow-up was 3 months. Variables were compared using chi-square and Wilcoxon tests.

RESULTS: Overall, 115 complications were reported in 98 of 233 patients (42%) and significantly decreased after 175 procedures (P = .028). Minor complications (Clavien grades 1-2) represented the most frequent events (86 of 115 [75%]), with a significant drop in group 4 (P < .01). Similarly, the rate of positioning injuries (groups 1-4: 31%, 29%, 29%, and 7%, respectively) showed a significant improvement in group 4 (P = .023). Creatine kinase levels significantly decreased with increased experience (group 1 vs groups 2-4: P < .01). Renal function was unaltered postoperatively.

CONCLUSION: A surgeon with extensive open and laparoscopic experience presents a safe learning curve in regard to robot-assisted radical prostatectomy and extended pelvic lymph node dissection. With increasing experience, the rates of overall and positioning-related complications significantly decrease after 175 procedures. No detrimental effect on renal function is to be expected.

Written by:
Di Pierro GB, Wirth JG, Ferrari M, Danuser H, Mattei A.   Are you the author?
Klinik für Urologie, Luzerner Kantosspital, Lucerne, Switzerland; Department of Obstetrics, Gynecology and Urology, 'Sapienza' University, Rome, Italy; Service d'Urologie, HUG et Faculté de Médecine, Geneva, Switzerland.  

Reference: Urology. 2014 Nov;84(5):1106-11.
doi: 10.1016/j.urology.2014.06.047


PubMed Abstract
PMID: 25443913

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